Technium | Service Provider Application Form

Title

First name

Surname

Position

Organisation

Address

Postcode

Telephone

Fax

E-mail address

Web-site

Section 2 - Company Details

Year established

Nature of business

Company Profile - Please provide a brief description of your organisation (approx 200 words)

What type of services do you provide?(to select more than one option, please click on text whilst holding down Ctrl key)

If other, please state

What methods would you consider for delivering support? (please select)

How frequent would you be willing to provide support? (please select)

Where would you be willing to travel to provide support? (please select)

Describe the support you are able to offer Technium companies

Demonstrate briefly your experience of working with and/or supporting Technium or early stage technology/knowledge based companies (Additional documentation can be emailed to enquiries@technium.co.uk

References- Please provide details of 3 recent clients whom we can approach to obtain a reference

How did you hear about the Technium Professional Service Provider programme?

Any other comments: (Please email any suporting documentation to the project coordinator at enquiries@technium.co.uk

Technium Innovation Centres

Service Provider Application Form