4i Innovation Application Form

4i Innovation Application Form

Ballymena Business Centre in Partnership with The Gallaher Trust and Innovate NI
Name*

First NameLast Name
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone / Mobile*
Email Address*
Website / Social Media*
4i Innovation Criteria [please tick]*

I am over 18 years oldMy business is based in the greater Ballymena area [previous Ballymena Council]I have identified potential opportunities to grow my businessI will actively participate in all aspects of the 4i Innovation
Business Sector*
Business Status*
Company Registration Number [if applicable]
Business Start Date*

DayMonthYear
Date
Annual Turnover Band*

Percentage of Annual Sales by Region*

	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]*

Number of Attendees Participating on 4i Innovation [up to 3 per business]*
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*

Clear
Date*

DayMonthYear
Date
Should be Empty: