Assigned Artist Advances Application Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email* Phone*Employer Name*If music/entertainment is your full-time job, please use SELF EMPLOYED Birthday*DD/MM/YYYYWeekly Income*Under $250Between $300-$500Between $500-$1000Over $1000How Long Have You Worked There*Less than 3 monthsBetween 6-12 monthsOver 12 monthsAmount Of Funding Needed*$300.00-$499.00 (Rookie) APT Fee - $10.30$500.00-$1,000.00 (Starter) APT Fee - $20.30$1,001-$4,999.00 (Pro) APT Fee - $30.75Minimum of 30% Deposit required + APT Fee Example: 500 Advance x 30% deposit = $150.00 APT Fee = $31.30 Total: 181.30How Much Money Are You Investing In This Project?*$0.00-$99.00$100.00-$499.00$500.00-$1000.00Over $1000.00Please Select Your Collateral Type*Gold and Silver Jewellery (Rings, Chains, Earings, Bracelets, Pendants and/or Watches) Estimated Value $200 - $975Vehicle Title (Clear of any bank liens) Estimated Value $1000 - $5000Other (Value must of Collateral greater than $5000)Please see the Benjamin Verde Terms and Conditions for more information on Collateral Rules.Reason for Artist Advance*Select OneRecordingMarketing and PromotionVideoEquipmentBusiness FundingHow Did You Hear About Benjamin Verde Inc?*Please provide the name of the Company or Person that taold you about usPlease Provide The Name, Email And Phone # Of The Company Or Person You've Hired**Please provide the contact information of the Company or Person that you have already hired or would like to utilize to complete your project.Terms And Conditions* I Accept the Terms and Conditions Assigned Artist Agreement* I Accept the Assigned Artist Agreement Additional Documents And Material* • I Accept the Terms and Conditions above and agree to provide valid ID, proof of address along with any other documents or information requested within 48 hours after receiving my Benjamin Verde invoice. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.