Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Email Address:

Question Title

* 4. Phone Number:

Question Title

* 5. Alternate Phone Number:

Question Title

* 6. Business Name:

Question Title

* 7. Business Start Date (if applicable):

Question Title

* 8. Business Address:

Question Title

* 9. Business Website:

Question Title

* 10. How did you hear about Starter Company Plus?

Question Title

* 11. Application Type:

Question Title

* 12. Amount Requested from Starter Company Plus:
(max $5,000)

Question Title

* 13. Grant money to be used for:

Question Title

* 14. Provide an overview of the business:

Question Title

* 15. Please check all that apply to confirm your eligibility in the Starter Company Plus Program:

Question Title

* 16. Please check all that apply to confirm you understand some of the Starter Company Plus requirements.  Additional information can be found at: www.regionalbusiness.ca/startercompanyplus

Question Title

* 17. By agreeing below, as the Applicant or an authorized signing officer of the Applicant, I certify to the Regional Business Centre that the information contained in this Application Form, which includes the supporting documentation submitted herewith, is true and complete in all respects.  If the Regional Business Centre discovers that the Application Form contains any material misrepresentation, this Application Form shall be deemed to be withdrawn immediately by the Applicant.  I agree to provide any additional information that the Regional Business Centre or its authorized program administrator may reasonably require for the purposes of assessing this Application Form and administering its Starter Company Plus fund.  I am also required to report back to the Regional Business Centre detailing revenues, cash-flow, hiring and other business details as requested.

T