Clone of Enrollment Agreement

Enrollment Agreement

Thank you for your interest in enrolling with Cred Tech Ai. Please complete the information below so we can get your Practice set up, and we can identify the lenders in our portfolio that will be the best fit for your Practice. If you have any questions, please call (844) 995-4657.
What is the legal name of your Practice*
Make sure you include (LLC, PA, Inc)
What is your Practice specialty (i.e. Chiropractic, Plastic Surgery, etc.)*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice Phone Number*
Format: (000) 000-0000.
What is the Practice email*
Who is the contact person we should call or email?*

First NameLast Name
Contact person's phone number if different than above
Please enter a valid phone number.Format: (000) 000-0000.
Contact person's email if different than above
example@example.com
What is your Practice website?*
What is the Doctor's or Owner's name*

First NameLast Name
How many loans do you close every month?*
What is your average loan amount?*
Please list the patient financing companies you are currently using.
Please review the following lender program options, and let us know which of these programs you would like to enroll to use. NOTE: These are third party lender programs.
Prime Credit:

Lender programs for people with credit scores above 680. Loan amounts up to $35,000. Terms up to 60 months. APR's between 6.9% and 19.9%. Most offers include 12 months same as cash. The typical fee to your Practice is 7%. Do you want to offer these programs?
YesNoI want to learn more
Average Credit:

Lender programs for people with credit scores between 640 to 679. Loan amounts up to $25,000. Terms up to 60 months. APR's between 12.9% and 21.9%. Most offers include 12 months same as cash. The typical fee to your Practice is 12%. Do you want to offer these programs?
YesNoI want to learn more
Fair Credit:

Lender programs for people with credit scores between 600 and 639. Loan amounts up to $15,000. Terms up to 48 months. APR's between 12.9% and 24.9%. The typical fee to your Practice is 15%. Do you want to offer these programs?
YesNoI want to learn more
Poor Credit:

Lender programs for people with credit scores between 550 and 599. Loan amounts up to $15,000. Terms up to 48 months. APR's between 16.9% and 29.9%. The typical fee to your Practice is 22%. Do you want to offer these programs?
YesNoI want to learn more
Bad Credit:

Lender programs for people with credit scores of 549 or below. Loan amounts up to $6,000. Terms up to 24 months. APR's between 18.9% and 35.9%. The typical fee to your Practice is 25%. Do you want to offer these programs?
YesNoI want to learn more
Fee Disclosure:

CredTech Ai is a technology company only. As such, we charge a flat User Licensing Fee to use our technology if the Applicant is approved and they accept a loan offer with any lender. The fee we charge on each accepted loan offer will be based on the "average loan amount" as you entered above. For example; If you said that your average loan amount is $5000, the User Fee for all of your requests will $375. Please use the chart below as a guide so you understand what fee will be charged on each of your accepted loans. We will examine your average loan amount every six months to determine if we need to adjust your fee schedule. NOTE: You are encouraged to make the Patient/Applicant aware of this fee and require them to pay for it by adding it to the base loan amount requested. But as an Enrolled Provider contracting to use our services, you are responsible to pay the fee after each funding.
Loan Amounts up to $2,499.99 / The fee is $175Loan Amounts of $2,500 up to $14,999.99 / The fee is $375Loan Amounts of $15,000 up to $24,999.99 / The fee is $575Loan Amounts of $25,000 and up / The fee is $775
YesNo, cancel my enrollment
Minimum Monthly Production:

As a business, CredTech Ai incurs on-going monthly costs for every business that has access to our platform. As such, we cannot have a company set up to use our platform and then never actually use it. For that reason, we require your Practice to guarantee a minimum monthly revenue generation of $375. In most cases, that equates to only one loan funding per month. But if we do not collect a minimum of $375 from your Practice in any one month, we will invoice you for any shortfall of such.
YesNo, cancel my enrollment
Set Up Deposit:

There is a lot of time spent getting most businesses set up to use our platform and with the lender onboarding. Therefore, we cannot have a Practice signing up "just because it is free". As such, we charge a one-time set up deposit of $375. But as a deposit, this fee will be credited back to you after six months using the platform or 10 closed transactions (whichever happens first). PLEASE NOTE: We will send you an invoice for this deposit after we receive this form back. However, we will not start your onboarding until the deposit is paid.
YesNo, cancel my enrollment
Enrollment Term:

This agreement will be based on a month-to-month agreement that can be cancelled by either party with a 30 days' notice. However, if you have an outstanding balance at time of cancellation, you will be required to pay that balance within 30 days.
What happens next:

Once you submit this form, you will be directed to complete the lender onboarding form. This is the form we use to collect all the documentation the lenders normally require when enrolling. Once we get that form completed and the supporting documentation, we will start the process of getting you set up with the lenders. NOTE: The normal turn-around time for onboarding is two weeks.
Thank you for submitting your enrollment request. If you have any questions or concerns, please call (844) 995-4657.
Should be Empty:

Enrollment Agreement

Prime Credit:

Average Credit:

Fair Credit:

Poor Credit:

Bad Credit:

Fee Disclosure:

Minimum Monthly Production:

Set Up Deposit:

Enrollment Term:

What happens next: