Signup To Begin Offering LendingPoint Merchant Solutions Information on Person Completing This Application Your First Name Your Last Name Title Email Phone Did Anyone Tell You About LendingPoint?Please select... YES NO First Name Last Name Company Name (if applicable) Email LendingPoint Partner ID Basic Business Information Company Name DBA Tax ID Street Address City StatePlease select... AL AK AZ AR CA CO CT DC 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 Zip Code # Of Years In Business Website Are You Currently Partnered With Any Other Consumer Finance Companies?YesNo If Yes, Who? How Many Agents Do You Have?Please select... Only Myself Between 2-10 Agents Between 10-25 Agents Between 25-100 Agents Between 100-500 Agents Over 500 Agents How Many Existing Merchants Do You Have That Might Be Interested In LendingPoint?Please select... 0 Between 1-10 Between 10-25 Between 25-100 Between 100-500 Between 500-1000 Over 1000 Which Of The Following Industries Do You Have Merchants In Today?Furniture & MattressConsumer GoodsHome ImprovementMedical ServicesMedical DevicesAutomotive Service & RepairFuneralPowersports Principal Information Principal First Name Principal Last Name Principal Email Principal Home Phone Principal Mobile Phone Principal DOB Principal Driver's License # Drivers License StatePlease select... AL AK AZ AR CA CO CT DC 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 Driver's License Exp. Date Has the principal ever been convicted of a felony?YesNo Please provide brief explanation of your legal history Direct Deposit Setup Financial Institution Name Name on Account Bank Account TypePlease select... Business Checking Routing Number Account Number Select Today's Date Need assistance with this form?
