First name

Last name

Email Address

Enter business name

Business Description

How long is the business established? How long is the business established? Pre start up (not yet trading) 1-12 months 2-3 years other

Please provide a brief description of the promoters background including relevant experience, training, industry knowledge etc. Promotors are anyone who will be involved in the management or running of the business.

Does the proposed business have the potential to generate additional employment opportunites in the next 12 months? Does the proposed business have the potential to generate additional employment opportunites in the next 12 months? Yes No

How many employees? How many employees? 1-2 Employees 5+ Employees 15+ Employees

Type of unit required Type of unit required Office Light Industrial Production Kitchen Other

Size of unit required (sq ft or sq meters SPECIFY)

Enter email address

Enter contact phone number

Enter Website url

Enter Facebook url

Enter Twitter url

Enter Instagram url

Enter LinkedIn url

How did you hear about BASE? How did you hear about BASE? Fingal Local Enterprise Office Fingal County Council NACEC Website Chamber of Commerce Referred from another Enterprise Centre EMPOWER Internet search Social Media Personal referral Word of mouth

I wish to be considered for an incubator/enterprise unit in the BASE Centre and i declare that the information given is true to the best of my knowledge I wish to be considered for an incubator/enterprise unit in the BASE Centre and i declare that the information given is true to the best of my knowledge Yes

I consent To BASE using the data entered should my business become a tenant, such as social media details, business description and business contact details to create a business profile page on the BASE Enterprise Centre website I consent To BASE using the data entered should my business become a tenant, such as social media details, business description and business contact details to create a business profile page on the BASE Enterprise Centre website Yes No