Kannur Technolodge Application Form
Name of Industry /organization/ Institute / Entrepreneur:
Name of Contact Person:
Designation*:
Address:
Fax:
Phone No.:
E.mail:
Nature of Business:
Stage of Business (Please select one):
Choose One
Initial (Conceptual)
Development (R&D)
Technology /Product Formulation
Others
Number of people involved:
Reason for applying at Kannur Technolodge:
Space Required:
Choose One
Office Space
Shared Workspace
Period for which the space is required:
Choose One
≤3 Months
3-6 Months
> 6 Months
References (At least three) with name, Organization, Designation, Contact Details:
Other support/services expected from Kannur Technolodge(Mark the required):
Telephone
Internet
Use of conference room
Advisory/Monitoring Services
Accounting Services
If accepted as incubatee, the minimum period before occupancy:
Any other relevant information:
The information provided above is true. Further the information given falls in public domain and I/we promise to abide by the terms of MoU to be signed between me/us and Kannur Technolodge
Submit