Cleantech Research and Innovation Fund | eServices Prince Edward Island

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01, as it relates directly to and is necessary for the Cleantech Research and Innovation Fund application administered by the Department. If you have any questions about this collection of personal information, please email connect@cleantechpei.ca or call 1-902-218-4258.

Identification

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

I am applying as a/an: