4i Innovation Application Form
Ballymena Business Centre in Partnership with The Gallaher Trust and Innovate NI
Name
*
First Name
Last Name
Business Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone / Mobile
*
Email Address
*
Website / Social Media
*
4i Innovation Criteria [please tick]
*
I am over 18 years old
My business is based in the greater Ballymena area [previous Ballymena Council]
I have identified potential opportunities to grow my business
I will actively participate in all aspects of the 4i Innovation
Business Sector
*
Please Select
Hospitality
Food
Agriculture
Creative Arts
Professional Services
Construction
Domestic Services
Education
Recreation
Retail
Health
Digital
Manufacturing
Motor Trades
Professional
Property
Tourism
Wholesale
Trade Services
Other
Business Status
*
Please Select
Sole Trader
Partnership
Social Enterprise / CIC
Limited Company
Co-operative
Other
Company Registration Number [if applicable]
Business Start Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Annual Turnover Band
*
Please Select
Under £85k
£85k to £250k
Over £250k
Percentage of Annual Sales by Region
*
Rows
Local NI
ROI / Rest UK
Rest of World
Percentage
Current Number of Employees and Projected Number over next 3 Years [Part Time Under 16 hours Per Week]
*
Rows
Current
Full Time
Current
Part Time
Projected
Full Time
Projected
Part Time
Directors
Managerial
Technical
Skilled
Semi Skilled
Clerical
Manual
Apprentices
Number of Attendees Participating on 4i Innovation [up to 3 per business]
*
Please Select
One
Two
Three
Previous business support received....
*
maximum 100 words
Describe your business activity....
*
Have you identified a new problem or opportunity for your business?
*
maximum 100 words
What are the key areas of focus for your business in the next 3 years?
*
maximum 100 words
How do you feel you would benefit by participating on the 4i Innovation?
*
maximum 100 words
Signature
*
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: