Broker Onboarding Application Form

Basic Information

Full Name *

Company Name

Address

Street Address *

City *

State *

Country *

Postal code *

Social Security number *

Phone Number *

Company EIN number *

Email Address *

Website (if any)

Professional Details

License Number (if applicable)

State of Licensure *

Years of Experience in Lending/Brokerage *

Are you an independent broker or part of a network? *

Independent Broker

Broker Network

Loan Types & Experience

Average Loan Size Closed (USD): *

< $500,000

$500,000 - $1M

$1M - $5M

> $5M

Broker Fee Agreement

What is your standard broker fee? ( % OR USD) *

Are you open to co-broker deals? *

Yes

No

Compliance & Background Information

Have you ever been involved in litigation or regulatory action related to your brokerage activities? *

Yes

No

Do you carry Errors and Omissions (E&O) Insurance? *

Yes

No

Referral and Payment Information

How do you prefer to receive payments? *

Bank Transfer

Check

Other

Bank Account Details for Payment (if applicable) *

Mercury Bank will request payment if it comes from Invest Fund Groups

Supporting Documents

Broker License *

E&O Insurance Certificate *

W-9 Form *

General Liability Insurance Certificate

Terms & Conditions *

By submitting this form, I confirm that the information provided is accurate and complete. I agree to abide by the terms and policies of **Invest Fund Groups LLC**.