Start Up Seed Fund Application Form

Name:*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

National Insurance Number*

National Insurance Number or Similar

Phone Number*

Email Address*

emample@emample.co.uk

Business Name*

Name of Your Business

Date You Started Your Business*

Date

Describe Your Business*

Maximum 100 Words

To be eligible you should fulfil the following criteria. Please Tick*

I am over 18 years oldI will be working in my business over 16 hours per weekI have completed the Go Succeed Business PlanI have registered as e.g. self employed or LtdI am a resident in greater Ballymena and / orI will be starting my business in greater BallymenaI have no current criminal record or bankrupcyI have started my business within 6 months

Those who are eligible will be invited to make a short presentation. A sample persentation template has been attached for you to download. Following presentation you will be issued with an agreement to receive £500 Seed Fund. This will be paid by BACs into a bank account suitable for business use and is to be spent on business use within the greater Ballymena area. Upon receipt of your application I will issue you with a date and time for your presentation. Any questions you may have can be emailed to melanie@ballymenabusiness.co.uk or phone 07930358982

E-Signature*

Submission Date*

Date