IBO Application TEST PAGE – Tim Dahn

Thank you for your interest in becoming an IBO (Independent Business Organization) with 117 Degrees LLC. Welcome aboard! The first step is to complete and submit the following information to qualify you for an IBO. The team at 117 Degrees will work with you to move this process along. Please respond to requests quickly, this will ensure a smooth campaign.

IBO Application

117 Degrees Contact:(Required)

First Last

Person Who Referred You:(Required)

First Last

Please Provide The Following:

Date(Required)

Name of Applicant(Required)

First Last

SSN(Required)

Date of Birth(Required)

Main Contact Phone Number(Required)

Email Address(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Number of years you lived in your current home?(Required)

Employer(Required)

Driver's License Number(Required)

Issuing State(Required)

State

Do You Have A Passport(Required)

Yes

If yes, please provide the expiration date.

Estimated Credit Score(Required)

Have you ever been convicted of a felony?(Required)

Yes

Have you filed for bankruptcy in the last 7 years?(Required)

Yes

Preferred LLC Name(Required)

(117 Degrees can create one)

What address would you like your payments sent to?(Required)

Street Address Address Line 2 City State ZIP Code

List of documents needed to get started

2 Years Tax Returns(Required)

Drop files here or

Max. file size: 5 MB.

Signed W-9(Required)

Drop files here or

Max. file size: 5 MB.

3 Months Bank Statements (most current)(Required)

We will ask for more throughout the life of the campaign...

Drop files here or

Max. file size: 5 MB.

Copy of Your Social Security Card(Required)

Drop files here or

Max. file size: 5 MB.

Clear and Color Copy of Your Driver’s License, Front and Back(Required)

Drop files here or

Max. file size: 5 MB.

Copy of Your Current Month Utility Bill(Required)

Drop files here or

Max. file size: 5 MB.

Current Month Phone Bill(Required)

Drop files here or

Max. file size: 5 MB.

Copy of Your Credit Score(Required)

Drop files here or

Max. file size: 5 MB.

Signed IBO Agreement(Required)

Drop files here or

Max. file size: 5 MB.