Name

Email Address

Phone Number

Best Day/Time To Contact

Amount you are interested in investing (£)

Expected timeframe to invest Expected timeframe to investWithin 1 Month1 - 3 Months6 MonthsNot Sure

Have you invested under SEIS/EIS before Have you invested under SEIS/EIS beforeYesNo

Would you be interested in mentoring or advising the business? Would you be interested in mentoring or advising the business?YesNoMaybe