Business Details Name Business name Trading address Business trading address First line of address Second line of address City/Town Postcode Registered address Registered address is the same as the Trading address Yes No Business registered address First line of address Second line of address City/Town Postcode Other details Turnover 2019 £ Turnover 2020 £ Number of employees Your details Name Owner name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Contact Contact details Email Phone Web or Social media page address Business profile Business sector Specify which business sector you are in Specify which business sector you are in - Select -Advanced ManufacturingBusiness ServicesConstructionCreative and DigitalEnvironmental TechnologiesHealth and Social CareManufacturingReatailWarehousing and DistributionWholesaleOther… Enter other… Key dates Trading for at least a year? Yes No Business start date Main business bases Main customer base Main competitor base Challenges and Ambition Biggest challenges over the last 12 months Information to include Include COVID and non-COVID challenges, how you respond to them, what else you want to do. Your ambition for the business Information to include Include where you see the future opportunities, what you have done in support of them, what else you would want to do. Business support programmes Please list the names and dates of any business support programmes the business has participated in the last three years Details of business support programmes Disclaimer I confirm our business: Will adhere to current COVID-19 measures Will pay our business rates (if applicable) Is not insolvent Has not been a member of the FSB or Black Country Chamber within the last 12 months If our application is successful, we agree to actively participate in the Programme including: The Business Review Attending at least four of the Programme webinars The Financial Health Check and the Digital Review Quarterly Review calls Provision of turnover figures for 2021 Numbers of any jobs created and secured following the Programme support Contact information will also be shared with the FSB or the Chamber of Commerce to complete the membership application process We agree to actively participate in the Programme Data Protection As a Council, we provide a wide range of other services and support for the business community. We may wish to contact you about these services. Please contact me about other business services For further information, please consult our Privacy Notice. 16168
