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Professional Service Assistance Program Application Form

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

Company/Business Information


Company Name: *
Contact Person: *
Telephone: *
Address: *
Form of Organization:
Incorporated
To be Incorporated
Sole Proprietorship
Partnership
Cooperative
Other (specify)
If other, please specify:
Sector:
Manufacturing/Processing
Retail
Service
Tourism
Primary
Other
If other, please specify:
Business (HST) Number:
Enter your HST number, if applicable.
Application Received Date:
Project Officer:
Nature of Current Business


(include a history and description of your business, including products, services, markets served)
:
Description of proposed project or activity:
Amount of assistance requested $: *
Submitting your Quote


There are a number of options for submitting the quote from the professional advisory support of your choice.
:
Attach an electonic/scanned copy of the quote, if available.

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
Junior Business Development Officer
94 Euston Street 1st Floor
P.O. Box 910 Charlottetown PE C1A 7L9
Telephone (902)569-0571

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