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*

DayMonthYear
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 submit a seed fund agreement to receive £500. 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. Any questions you may have can be emailed to melanie@ballymenabusiness.co.uk or phone 07930358982
E-Signature*

Clear
Submission Date*

DayMonthYear
Date
Should be Empty: