Name
Address
Postcode
Telephone (home)
Telephone (work)
Fax
Mobile
Email
Previous Employment / Experience
Current Employer
Previous contact with Local Enterprise Agencies
Council Area		Please Select... Antrim Ards Armagh Ballymena Ballymoney Banbridge Belfast Carrickfergus Castlereagh Coleraine Cookstown Craigavon Derry Down Dungannon Fermanagh Larne Limavady Lisburn Magherafelt Moyle Newry & Mourne Newtownabbey North Down Omagh Strabane
MLA Constituency		Please Select... Belfast East Belfast North Belfast South Belfast West East Antrim East Londonderry Fermanagh and South Tyrone Foyle Lagan Valley Mid Ulster Newry and Armagh North Antrim North Down South Antrim South Down Strangford Upper Bann West Tyrone
Westminster Constituency		Please Select... Belfast East Belfast North Belfast South Belfast West East Antrim East Londonderry Fermanagh and South Tyrone Foyle Lagan Valley Mid Ulster Newry and Armagh North Antrim North Down South Antrim South Down Strangford Upper Bann West Tyrone
Description
What prompted your idea?
How long have you been developing your idea?
Is there a prototype available?		Yes No
Is your idea legally protected? Please tick the appropriate section		Patent Application Filed Patent Granted Registered Design Design Rights Copyright None
Has a patent or product search being undertaken?		Yes No
Have you any market research information? e.g. Who would use your product? Estimate the potential market size? Do you have any competitors? What are the advantages of your idea being developed?
In which particular areas do you feel ‘BIL’ could assist you?
What are your future plans? (Please tick where appropriate)		Consider manufacturing Prepare to license Other arrangements i.e. partnership / subcontract
How many hours are you prepared to devote to this project (e.g. 2 hours per week, 20 hours per week, etc)

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