Apply - LendingUSA

Merchant Enrollment

Please complete the following form to get started. Once completed you will have access to our online provider portal.

128-bit SSL protection and strict encryption

Business Information

Legal Business Name

D.B.A. Optional

Street Address - Line 1

Street Address - Line 2 Optional

City

State

Zip

Business Product/Service Type

Products/Services Sold

Federal Tax ID# Or SSN#

Contact Information

Approval and application status will be sent to the following.

First Name

Last Name

Title/Position

Email Address

Main Office Phone #

Fax Number

Owner Information

Owner First Name

Owner Last Name

Street Address - Line 1

Street Address - Line 2 Optional

City

State

Zip

Create Your LendingUSA Login

Username

Password 8 characters or more, 1 special symbol or one digit

Your Signature

Electronic Signature Agreement. By selecting the “Submit Application” button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide LendingUSA.com, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and LendingUSA.com. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a LendingUSA.com service constitutes your agreement to be bound by the terms and conditions of the LendingUSA.com Disclosures and Agreements as they exist on the date of your E-Signature.

Check here to agree to Terms of Use Agreement, Policy, Platform Access & Use Agreement, Operating Procedures, and digitally sign this form.

Owner's E-Signature

Title

Date