Intro text here… Business Name*ABNAddress* Street Address Address Line 2 Town/Place State Postcode Your Name First Last Title/PositionEmail PhoneBusiness Type*CompanyPartnershipSole TraderTrustOtherAdvise the Trustee Entity*If 'Other', advise your entity type*What is your turnover (i.e. sales/revenue)?* Less than $500,000 $500K - $2.5M $2.5M - $5M Greater than $5M Number of Employees (including self):*Have you accessed any other programs through RDA Barossa Inc that provided you a subsidy or any financial support?*YesNoIf 'Yes', please provide details of the assistance received.*Which of the following council areas is your business located?* The Barossa Council The Town of Gawler Light Regional Council District Council of Mallala Any additional information for your ApplicationDescribe the services you are seeking or the issues you need assistance resolving*Do you have a preferred B2B service provider for the assignment?*YesNo / Whoever is most appropriateIf 'Yes", please advise the B2B who is your preference*I warrant that the information provided above is true and correct to the best of my knowledge. I agree for this information together with a brief summary of recommendations prepared by the Service Provider for the abovementioned business to be provided by the Service Provider to RDA Barossa Inc in order that the provision of services by the Service Provider be considered for the fee subsidy from RDA Barossa Inc to the abovementioned business for a maximum of 2 hours work by the Service Provider. I acknowledge that:- • the provision of the fee subsidy is at the sole discretion of RDA Barossa Inc; and • RDA Barossa Inc will maintain strict confidentiality of the information provided in order to assess the provision of the fee subsidy and shall not use this information for any other purpose whatsoever, without the prior written consent of the abovementioned business. Check 'YES' to confirm your declaration and finalise the application.* YES Subscribe to RDA Barossa and B2B E-news YES This iframe contains the logic required to handle Ajax powered Gravity Forms.
