1. Promoter

* Name:

Address:

Landline Phone:

* Mobile Phone

* Email Address:

3rd Level Qualification:

Give brief details of your employment history to date:

2. Proposed Product/Service

Give details of your proposed product/service:

Have you undertaken any development work on your proposed product/service?

Yes
No

If yes, please give details:

Have you carried out research on your proposed product/service?

Yes
No

If yes, please give details (e.g. size of markets, market segment, competitors, expected market share, distribution):

Have you/do you plan to receive any support from the State Development Agencies (e.g. Enterprise Ireland, Enterprise Boards etc.):

3. The Genesis Enterprise Programme

What do you expect to get from the Genesis programme?

How did you hear about the Genesis Programme?

Note: Before you submit it's a good idea to save all the data from the form to Notepad, Word or other text editor just in case if there would be a problem with submitting your data.

  

* Required fields