Growth Service Helpline Webform

Contact Details

Title
Forename *
Surname *
Telephone
Mobile Phone
Email *
Position

Company Details

Registered business name *
Web Site
Company Description
Date Established
Business Stage
Number of Employees
Annual Turnover (£)
Postcode:
Building Name:
Secondary Name:
Street:
District:
Town:
County:
Who do you pay business rates to

Enquiry Details

Brief Conversation / Action Summary
Business Needs *











How did you hear about the service?














We would like to share your business data with our partners so that we can keep you informed about opportunities to support your business and evaluate the service. We will not share information that is commercially or personally sensitive. Are you ok with that?
Permission to Share Details
Add to mailing list
Date Enquiry was Registered

Action Referrals

Referral Contact Signposted Only Referral Due Staff Member
Growth Manager Referral
Growth Manager Referral
Enquiry Level *


Source of enquiry *
Consultant on behalf of SME
Sector *
Sector 2
SIC Codes

PUBLIC FUNDING DECLARATION

Eligibility for ERDF assistance is dependent in part upon the beneficiary not exceeding a de-minimis threshold of €200,000 of public funding in any period of three fiscal years (the current fiscal year & previous two) and any de-minimis aid granted over the €200,000 limit may be subject to repayment with interest. If you have received any de-minimis aid in the last three fiscal years you should inform us immediately with details of the dates and amounts received. Furthermore, information on aid provided by any of the delivery partners on this project must be supplied to any other public authority or agency asking for information on de-minimis aid for the next three fiscal years.

Details of previous funding





Funding source and activity funded Award date Amount (£) Amount (€ *)
 
 
 
 
 
* Official European Commission currency convertor: Please ensure you use the month and year the funding was received to work out the exchange rate. http://ec.europa.eu/budget/contracts_grants/info_contracts/inforeuro/inforeuro_en.cfm Totals Totals

DECLARATION BY APPLICANT

To be eligible to receive support from this project, your company must agree to share information when requested, and provide certain information and statements over the duration of the support period and in the future. This information could include signed statements confirming support to the enterprise, jobs created; financial details, employment contracts and company incorporation statements. Any personal information collected will be used for monitoring and reporting purposes only.



I consent to use of my personal information for monitoring and reporting purposes as described in the Data Protection Notice below



I agree that our company will supply information when requested and declare that the information provided in this form is accurate and complete to the best of my knowledge. I consent to the use of this information for the purposes described in the Data Protection Notice below.

Client's signature: Print name:
Position: Date:

DATA PROTECTION Notice.

How we use your information

This privacy notice tells you what to expect when you give your consent for information collected in this form to be used.

Why do we collect this information?

Project delivery partners are obligated by EU law and our external funding bodies to collect information which will determine if a Company is eligible for assistance and in order that we can report on our contracted project outputs and outcomes.

Who will your information be shared with?

The information held on this form will be kept on computer and in project files which are accessed project delivery teams and third parties, including:
• Project delivery partners (for example: Local Authorities and public/private organisations)
• Independent Auditors (for example: Funding Bodies)

The information is shared to:

• ensure compliance to EU eligibility regulations,
• verify outputs claimed via a project
and
• may be passed to other project delivery teams who may contact you with details of other services in which you may be interested.

Personal Information

Personal information is collected for monitoring purposes to assist with reporting project outcomes to external funding bodies and project partners. This will be shared in an aggregated format. Individual personal information may be shared with a 3rd party consultant during project evaluation to enable this reporting.