Your Name (required)

Your Email (required)

Business Name (required)

Home or Business Address (including postcode- must be in West Midlands) (required)

Telephone Number (required)

Select the sector of your business:
 IT/Web/Digital Media
 Green/Clean Tech
 Bio Tech
 Medical Tech

How did you hear about us? (required)

Which of the following best describes the stage of your business?
 Idea
 Research/Planning
 Prototype
 In Operation (Product launched but not yet trading)
 Revenue Generating
 Revenue Generating and seeking investment

What Product/Service are you going to provide?

What is really different and smart about this? Your idea must be innovative.

What is the problem you are solving?

Who are (and might be) your competitors? Don’t say none. *

Who is the target audience for the product/service?

How will you make money? *

How much time will you spend on this business?
 Full-Time
 Part-Time

Do you currently have other work?
 Yes
 No

How many people in your team?
 1
 2
 3
 4

Do you have the core skills in your team to deliver this business?
 Yes
 No

If no to above - what skills do you require?

What support do you think you need from the incubator?

Is your business registered as a Ltd company with Companies House?
 Yes
 No
 Not sure

Have you started trading?
 Yes
 No

Do you need startup funding?
 Yes
 No

If yes to above how much?

What is your predicted revenue in Year 1?

What is your predicted revenue in Year 2?

What is your predicted revenue in Year 3?

How much will you charge for your product/service?

How will you find your 1st customer?

If you have a business plan, please upload it here:

I understand that if I am accepted into the e4f incubator my team and I will be expected to be based at the incubator (Faraday Wharf, Birmingham Science Park Aston, Birmingham).
I understand that e4f is part-funded by the European Regional Development Fund and the support is offered under the European Commission’s De Minimis regulation (Regulation 69/2001). This allows a company to receive up to 200,000 euros of De Minimis aid over a three year period.
To confirm that you are able to receive this assistance you must therefore declare the full amount of De Minimis aid you have already received over the last 36 months once you have been accepted onto the scheme.