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Business Development Application

Fields marked with a red star (*) are mandatory.

Section I


Company Name: *
Legal Name (if different): *
Mailing Address: *
Civic Address: *
Contact Person


Name: *
Title: *
Phone: *
Fax:
Email: *
Website:
Business Information


Business Number (BN):
In business since: *
Total Annual Sales: *
Total Annual Exports: *
# of PEI Employees: *
full-time
# of PEI Employees: *
part-time
Business Sector: *
Aerospace
Bioscience
Information Technology
Renewable Energy
Advanced Manufacturing
Craft & Giftware
Food Development
Services
Other
if Other:
Type of Organization: *
Incorporated
To Be Incorporated
Federally Incorporated
Partnership
Sole Proprietorship
Cooperative
Other: (Specify)
if Other:
Section II


Location (or proposed location) of project or activity:
Estimated number of new jobs to be created by project or activity


Full-time:
Part-time: *
Estimated number of permanent jobs maintained by project activity


Full-time: *
Part-time: *
Project activity period: *
Esitmated start date
Project activity period: *
Estimated completion date
Section III


Applicants are required to submit supporting documentation in the form of an attachment:
Outline the history and description of your business
Existing businesses are required to provide
detailed Financial Statements for the previous two years.
New businesses and businesses planning expansion,
are required to submit complete business plans
List all shareholders and key management personnel
Describe the proposed project or activity in relation
to the products and/or services delivered
by your company
Describe the economic benefits to your organization and
to Prince Edward Island
Provide detailed information on the estimated costs of
the proposed project or activity. (Cost
estimates should be supported by written quotations)
Outline all financial sources and provide appropriate
contact information. (For example, lending
institutions, banks, government loans and/or grants)
Describe the size and capacity of your existing facility
in relation to the proposed activity
Explain your current market position and identify your
projected market outlining any increases in
market share
Section IV


Applicants should also be prepared to provide the following:
Business Plan
Marketing Plan
Project Feasibility or Market Study
Competitive Analysis
Resume
If the application concerns a study, please provide the consultant's proposal(s) and the study's terms of reference. (Costs should be supported by written quotations.)


Project Costs


Land:
Land Improvements:
Building and Structures:
Machinery and Equipment:
Technology Cost:
Marketing Costs:
Wages:
Professional Services:
Other Costs:
TOTAL:
Financing for Project or Activity


Assistance requested under this application:
Other government assistance:
Existing working captial:
Long term loans:
Short term loans:
Additional equity:
Other (specify):
(This number should equal total submitted under "project costs.")

Investement offered by Innovation PEI is based on the creation of new wealth. The amount of investment is determined by the level


TOTAL:
Section V


Applying for:
Business Improvement Programs:
Human Resources Implementation
Information Technology Planning
Information Technology Implementation
Productivity Improvement Program
Quality Improvement Program
Business Start-Up & Expansion:
Capital Acquisition Program
Innovation & Development Labour Rebate
Rental Incentive Program
Tax Incentives:
Enriched Investment Tax Credit
Share Purchase Tax Credit
Specialized Labour Tax Credit
Trade and Marketing Assistance:
Marketing Support Program
Section VI


Applicant's Declaration, Consent and Disclosure Agreement

1. The information provided in this application is, to the best of my knowledge and ability, complete, true and correct.

2. The applicant consents to having Innovation PEI make any inquiries of such persons, firms, and corporations as it deems necessary in order to reach a decision on this application.

3. The applicant will provide all information required by Innovation PEI to complete the assessment of this application.

4. Information on this form is collected for the purpose of determining your suitability or eligibility for programs delivered by Innovation PEI. Information included in this form is subject to the Freedom of Information and Protection of Privacy Act. The amount of funding may be disclosed at the discretion of Innovation PEI and in accordance with the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01.

For additional information, visit www.gov.pe.ca/foipp

Signature of Authorized Official:
Date:
Print Name of Authorized Official:
Title:
Submitting your Documents


There are a number options for submitting supporting documents.:
Drop off at Business Development Officer's office
Fax to Buisness Development Officer
Mail to Business Development Officer
Attach to online submission
File 1:
File 2:
File 3:
File 4:
File 5:
File 6:

Do you want a copy of the form?


Please send me a simple text-only version of the information I submitted.
Please send me an Acrobat version of the form, with the information I've entered above filled in, that I can print and save.
Please send me both the text-only version and the PDF.
Important Note: Email is not, by its very nature, a secure medium; if you choose to have your form emailed to you, the information you entered will be transmitted over the public Internet to your email box.

Email to address:

Submit the Form


* There are several contact persons for this form. Please select the contact person from the list below to whom your form should be directed.

Steve Reaman (Innovation PEI )
Prince County
Business Development Officer
sjgreaman@gov.pe.ca

Access PEI Summerside
120 Harbour Drive
Summerside PE C1N 5L2
Phone (902) 888-8006/ Fax (902) 432-2634

Rural Action Centre Alberton
Box 368, 455 Main St
Alberton PE C0B 1B0
Phone (902) 853-0105; Fax (902) 853-3839
sjgreaman@gov.pe.ca

Rural Action Centre Central Bedeque
Box 3981
106 Linkletter Ave
Central Bedeque PE C0B 1G0
Phone (902)-887-3400; Fax (902)-887-2400
sjgreaman@gov.pe.ca

Preston Llewellyn (Innovation PEI )
Kings County
Business Development Officer
pkllewellyn@gov.pe.ca

Rural Action Centre Montague:
540 Main Street, Montague PE C0A 1R0
Telephone (902) 838-0609

Access PEI Souris:
Green Street, Souris PE C0A 2B0
Telephone (902) 687-7082

Melissa MacLaren (Innovation PEI )
Queens County
Business Development Officer
94 Euston Street 1st Floor
P.O. Box 910 Charlottetown PE C1A 7L9
Telephone (902)569-0571

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