Primary Email*
NOTE: This will be the primary way our team will directly communicate with you. Please make sure
our email, info@broadcastliving.com does not go into junk/spam.

Your First Name*

Your Last Name*

What is your Full Legal Name (exactly as illustrated on your Drivers License or Passport)?*

What is your primary Phone Number? *
NOTE: This will be the primary way our team communicates with you.

What is the name of the Referral Partner who recommended us? (please put full first and full last name)?*

Upload proof of your current Credit Score (from Experian, your Bank, or a Credit Card Company.) This will be verified upon application completion with our Advertising Partners:

(JPEG/PNG, or PDF Formats Only, Clear & Legible Image, All 4 Corners in view, Name must match the name you're applying with.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

Upload your form of Identification (Drivers License or Passport): FRONT IMAGE HERE

(JPEG/PNG, or PDF Formats Only, Clear & Legible Image, All 4 Corners in view, Name & Address should match the Name and Address you are applying with)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android!*

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload your form of Identification (Drivers License or Passport): BACK IMAGE HERE

(JPEG/PNG, or PDF Formats Only, Clear & Legible Image, All 4 Corners in view, Name & Address should match the Name and Address you are applying with)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android!*

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

We need the following information from your Drivers License:
(State Issued, DL Number, and Expiration Date (all required.)

1. State License is issued in?*
NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly. Please Select AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY DC AS GU MP PR UM VI

2. Drivers License Number?*
TIP: The number issued to you on your state issued Drivers License

3. Drivers License Expiration Date? *
TIP: Enter 2 digits for the month, 2 digits for the day, and 2 digits for the year.

What is your Date of Birth (MM/DD/YYYY)?*
TIP: Use 2 Digits for the Month, 2 Digits for the Day, and 4 Digits for the year.

What is your SS#?*
Format MUST Match: First 3 Digits - Second 3 Digits - Final Four Digits

What is your Primary Home Address?
(This should match the address on the documents you are applying with.)

1. Street Number, Name, & Unit Number (if applicable):*
This should be the address on all (or most) of the documents you are applying with.

2. City *

3. State/Region:*

4. Zip Code:*

Upload your Entire Federal Tax Return for 2022:
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, No Transcripts, No Extensions.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload your Entire Federal Tax Return for 2023:
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, No Transcripts, No Extensions.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload 3 most recent, consecutive, months of your Personal Bank Statements: Month 1
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, Name & Address MUST match the Primary one you are applying with.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload 3 most recent, consecutive, months of your Personal Bank Statements: Month 2
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, Name & Address MUST match the Primary one you are applying with.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload 3 most recent, consecutive, months of your Personal Bank Statements: Month 3
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, Name & Address MUST match the Primary one you are applying with.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Upload your most recent month's Telephone Bill:
(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, Phone Number MUST match with the Primary one you are applying with) >>> We DO accept family plans.

*If submitting a family plan, tell us your relationship to the primary account holder in the notes section provided after you upload this document. *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

If Needed, Telephone Bill Relationship Clarification
TIP: If submitting a family plan, please clarify your relationship to the account holder

Which Proof of Address document type will you be submitting?
(Lease, Mortgage, or Vehicle Registration are highly preferred)? *

NOTE: If you do not have one of these document types, please contact our team immidiately HERE for assistance.

Home Insurance Policy
Lease
Mortgage
Vehicle Insurance Policy
Vehicle Registration Card

Upload entireProof of Address document:

(ALL pages, PDF, Legible, All 4 Corners Showing, No Redactions, Name & Address MUST match the Primary one you are applying with.)

"Adobe Scan" App is an excellent FREE tool when needed for iPhone & Android! *

NOTE: If all of the above submission requirements are unmet, this application will be rejected, and you will be asked to resubmit. To save yourself and our team time, please submit correctly.

Will you be Moving from the Primary Address you have listed within the next 3-6 months? If so, please tell us when, and include the new address.*
NOTE: You will need to update the documents you have provided today with your new address and provide them as soon as they are available.

Do you have any extensive International travel plans in the next 3-6 months?*
NOTE: As explained during the Introduction Call, complete setup can take 3-6 months and, while we try to not utilize much of your time, we will need you to be available to communicate effectively.

*If you will be traveling internationally for longer than 3 weeks, please contact us HERE immidiately to discuss.
No, I have no travel plans in the next 3-6 months.
Yes, I will be traveling but for less than 3 weeks at a time
Yes, I will be traveling for longer than 3 weeks at a time
I'm relocating abroad
Other

Have you filed for Bankruptcy in the last 4 years?*
NOTE: If you have, but have since been cleared of your bankruptcy, please check YES and provide the paperwork clearing you for further review by our team below.
Yes
No
Other

Proof of Bankruptcy Clearanc

Do you have any current or outstanding liens or wage garnishments against you? (IRS back owed taxes, creditors, etc,.)*

NOTE: If your answer is yes, please submit proof of a responsible payment plan with the creditor owed below. If you do not have one setup, please contact us HERE immidiately and apply at a later time.
Yes
No
Other

Proof of Lien Clearance

Do you currently, or have you in the past 5 years, had Merchant ProcessingMerchant Processing (accepted online payments) for Health, Beauty, or CBD products?: (do not include payments for services rendered, Stripe, Square, PayPal or Venmo.)*

TIP: Please only select "Yes" if you have sold health or beauty products online in the past 5 years, especially in a Dropshipping and/or Trial/Subscription model.
Yes
No

Please provide your Personal Payment Information (where you want your monthly distribution to be directly deposited):

Bank Name:*

Account #:*

Routing #: *

Address on file associated with this account:*

Do you have PayPal (sometimes we give out bonuses and pay this way.) Include your handle or email associated with your account:*

Do you have Venmo (sometimes we give out bonuses and pay this way.) Include your handle or email associated with your account:*

Do you have another way we can quick pay you (example Zelle or CashApp). Please provide which you prefer and the email or phone number associated with the account:*

Do you consent to allowing Broadcastliving Inc to apply for a virtual mailbox, two C corporations, and merchant processing on your behalf in conjunction with your business relationship with one of their advertising partners?*
Yes
No