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Contact Details - Name*:

Business Address*:

Your email address*:

Telephone No.*:

Location*:

Please provide a brief description of your business proposal, and fully describe the problem you are solving*:

How are customers solving the problem today ?:

Who are your competitors and how are you different ?:

How many customers/users do you currently have ?:

What progress have you made in the last six months ?:

How do you plan to acquire customers ?:

What steps have you taken to validate the market ?:

What specific assistance do you require:
Business Plan
Funding advice
Business Mentor
Other

Do you think a patent could be applied to your proposition ?:
Yes
No
Already applied
Already secured

Have you previously applied for support/funding?:
Yes
No

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