Rios Business Advisors Qualification Form

1
Who Referred You?ie: Facebook, website or Name the friend or associate that referred you
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What service are you requestingService or Product Requesting
Credit Enrichment
Insurance
Taxes
Accounting
Payroll
Bookkeeping
Marketing
Loans
3
Credit Monitoring* This field is required.This is the tool we use for credit score monitoring. Please go to MyScoreIQ, sign up for $1.00 and then INPUT here your USERNAME and PASSWORD BELOW- PLEASE PUT THE REASON FOR WANTING CREDIT ENRICHMENT ie: Buy a house, refinance, buy a car, etc.
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Credit ScoresEquifax / Transunion / Experian
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Name* This field is required.
First Name
Last Name
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Date of BirthMM/ DD/ YYYY
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Social Security Number/ State originally issued* This field is required.
8
Drivers License / ID * This field is required.STATE/ ISSUE DATE / EXP DATE
9
Marital Status:* This field is required.
Single
Married
Other
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E-mail* This field is required.
example@example.com
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Home Phone* This field is required.
Area Code
Phone Number
12
Cell Phone* This field is required.
Area Code
Phone Number
13
Address* This field is required.
Street Address
Apt/Ste#
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
14
Month and Year when you moved into current address?
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If less than 2 years list Previous address - From / To MM/YY
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Present Employer* This field is required.Years At Current employer
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Hire Date MM/DD/YY?
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IF Self Employed/ Business Name & EIN (Employee ID Number)/Year Business started / LLC, S Corp, or Sole Prop IF NO BIZ put N/AADDRESS AND PHONE NUMBER
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19
How many employees do you have?
1 - 4
5 - 10
10 +
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What is the name of the decision maker for operations?
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Do you experience a high employee turnover rate?
YES
NO
N/A
22
What could business funding do for your business?
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Occupation/Title* This field is required.What you do for work
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Gross monthly income* This field is required.Before Taxes are taken out. Put hourly or Yearly income
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1. Current monthly rent or mortgage* This field is required.Dollar amount you pay currently
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Do you have any LIFE Insurance?Term, Whole or NONE?
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Reason for loan and loan amount?If no loan please put NA
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Please sign the Broker Service Agreeement for the _Rios Business Funding's 'Eye Level to High' Level Non-Recourse Program* This field is required.
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I authorize Rios Financial Group, LLC and its prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this credit and any other relationships we may establish from time to time. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies.* This field is required.
YES
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I hereby agree that the information given is true, accurate and complete as of the date of this application submission for the purchase of future receivables including merchant cash advance transactions. ** This field is required.
YES
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Please agree to terms and conditions* This field is required.
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Please Sign
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