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):

Number of people involved:

Reason for applying at Kannur Technolodge:

Space Required:

Period for which the space is required:

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