Submit New Merchant Package Below LendingPoint Partner Information Partner Email Address PLEASE MAKE SURE YOU ENTER THE EMAIL ADDRESS WE HAVE ON FILE FOR YOU! THIS IS IMPORTANT TO ENSURE WE PROPERLY TAG YOU TO THIS NEW MERCHANT ACCOUNT IN SALESFORCE. Your First Name Your Last Name Did you meet with this merchant face to face?Please select... Yes No If you didn't meet with the merchant face to face, how did you generate this merchant opportunity? Do you have an existing relationship with this merchant?Please select... YES NO Please explain your existing relationship Primary Point Of Contact First Name Last Name Title Email Phone Is This The Business Owner?Please select... Yes No Is This The Training Contact?Please select... Yes No Own 51% Or More Of The Business? Please select... Yes No Do Not Know LendingPoint Requires A 2nd Owner If Owner Owns Less Than 51%. Would You Like To Enter In Another Owner Now? Please select... Yes No Is There Another Business Owner You Would Like To Include?Please select... Yes No Owner #2 Information SalutationPlease select... Mr. Ms. Mrs. Dr. Prof. Owner Last Name Owner First Name Owner Title Owner Email Owner Phone Does This Owner Own 51% Or More Of The Business? Please select... Yes No Do Not Know Is This Owner The Training Contact?Please select... Yes No Basic Business Information Doing Business As Legal Business Name Website Annual Sales Revenue Average Transaction Amount Number of Locations Years in BusinessPlease select... Less than 1 1 2 3 4 5 More than 5 IndustryPlease select... Automotive Repair Consumer Goods Education Funeral Services Home Improvement Legal Medical Devices Medical Services Other Pets Powersports Vocational Training Primary Offering Within Consumer GoodsPlease select... Appliances Bicycles Campers & Trailers Camping Equipment Car Stereo & Alarm Electronics Exercise Equipment Furniture & Mattress Home Entertainment Systems Home Security Systems Jewelry Kids Playground Equipment Musical Instruments Other Product Over $1000 Outdoor Survival Gear Portable Spas & Hot Tubs Rims & Tires Sporting Goods Water Treatment Systems Secondary Offering Within Consumer GoodsPlease select... Appliances Bicycles Campers & Trailers Camping Equipment Car Stereo & Alarm Electronics Exercise Equipment Furniture & Mattress Home Entertainment Systems Home Security Systems Jewelry Kids Playground Equipment Musical Instruments Other Product Over $1000 Outdoor Survival Gear Portable Spas & Hot Tubs Rims & Tires Sporting Goods Water Treatment Systems Primary Offering Within Powersports Please select... ATV Dirt Bikes Golf Carts Jet Skis / Wave Runners Other Scooter & Moped Segways Snowmobiles Secondary Offering Within Powersports Please select... ATV Dirt Bikes Golf Carts Jet Skis / Wave Runners Other Scooter & Moped Segways Snowmobiles Primary Offering Within Home ImprovementPlease select... Artificual Turf Bath Remodel Baths & Showers Blinds / Window Treatments Cabinets/Countertops Chimney Repair Decks Doors Flooring & Tile Foundation Repair Garage Doors General Remodel Generators Gutters Home Entertainment Systems Home Security Systems HVAC In-Ground Pools Kitchen Remodel Landscaping Other Painting Plumbing Portable Spas & Hot Tubs Roofing Sheds & Gazebos Siding Solar Walkways Water Heaters Water Treatment Systems Wells Windows Wood Chippers, Sawmills & Splitters Secondary Offering Within Home ImprovementPlease select... Artificual Turf Bath Remodel Baths & Showers Blinds / Window Treatments Cabinets/Countertops Chimney Repair Decks Doors Flooring & Tile Foundation Repair Garage Doors General Remodel Generators Gutters Home Entertainment Systems Home Security Systems HVAC In-Ground Pools Kitchen Remodel Landscaping Other Painting Plumbing Portable Spas & Hot Tubs Roofing Sheds & Gazebos Siding Solar Walkways Water Heaters Water Treatment Systems Wells Windows Wood Chippers, Sawmills & Splitters Primary Offering Within Medical ServicesPlease select... Bariatric Surgery Chiropractic Cosmetic Dentistry Cosmetic Surgery Dermatology ED Treatments Fertility General Dentistry Hair Restoration Laser Hair Removal LASIK Med Spa Services Orthodontics Orthopedic Out of Pocket Medical Deductibles Permanent Makeup Plastic Surgery Podiatry Stem Cell Therapy Tattoo Removal Veterinary Secondary Offering Within Medical ServicesPlease select... Bariatric Surgery Chiropractic Cosmetic Dentistry Cosmetic Surgery Dermatology ED Treatments Fertility General Dentistry Hair Restoration Laser Hair Removal LASIK Med Spa Services Orthodontics Orthopedic Out of Pocket Medical Deductibles Permanent Makeup Plastic Surgery Podiatry Stem Cell Therapy Tattoo Removal Veterinary Primary Offering Within Medical DevicesPlease select... Chair Lifts General Medical Devices Hearing Aids Medical Beds Other Powered Scooters Powered Wheelchairs Secondary Offering Within Medical DevicesPlease select... Chair Lifts General Medical Devices Hearing Aids Medical Beds Other Powered Scooters Powered Wheelchairs Please Describe Your Industry & Service(s) Financing Information Do You Currently Offer Financing?Please select... Yes No Do You Advertise Financing To Your Customers Today?Please select... Yes No What Finance Companies Do You Partner With? Estimated # of Finance Opportunities a Month Briefly Describe The Products/Services That Will Be Financed Is an ISO SubmissionPlease select... Yes No ChannelPlease select... Direct ISO Need assistance with this form? We Look Forward To Serving Your New Merchant
