Clone of Enrollment Agreement 2026

Enrollment Agreement:

Thank you for your interest in enrolling with Credit Technologies and/or one of our subsideraies. 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 the average loan amount requested?

Please list the patient financing companies you are currently using.

If you were referred by anyone, please list their name here.

Fees Charged By Credit Technologies

Our offering was designed so that you can use our platform and technology at no final costs to your Practice. We do this by charging the Applicant a User Fee based on their loan amount. This fee is only charged if they get approved and they accept a loan offer. Furthermore, this fee becomes part of the new loan so they do not pay anything out of their pocket. Since the fee is financed, it will be paid to your Practice when you are paid by the lender. As a result, we will invoice your Practice for the collection of our fee after we have verified you have been funded.

Do you understand and agree to the fee structure and collection of such as outlined above?

Pick Your Pay-Out:

Credit Technologies has nothing to do with what the lenders charge as a Merchant Fee on any closing. However, we can control what your net payout will be on every transaction by allowing you to decide upfront what you will accept as your payout on every funding. This is what we call our "Pick Your Pay-Out" plan. Based on your willingness to pay a fixed fee on each funding (i.e. 10%), we will set up your platform so any fees (including the lenders and ours) above the percentage you are willing to pay, are automatically added to the loan amount and charged to the Applicant/Borrower.

For Example: If you agreed to pay a maximum fee of 10% on any funding, and due to the Applicant having poor credit the combination of the lender fee and our fee ends up being 18%, the Applicant will be responsible to finance the extra 8% so you will still net a 90% payout.

What is the Net Payout you want to receive on every transaction?

Enrollment Deposit:

There is a lot of work involved in getting your Practice enrolled with new lenders and setting up your platform. As such, we cannot afford to have a practice decide to enroll "just becuase it is free". As such, we charge an enrollment deposit of $375 that is rebated to your Practice as soon as you have funded the first $10,000 in loan volume through our platform.

NOTE: We will send you an invoice for this set up deposit after receiving this enrollment form.

Do you understand and accept the terms of the Enrollment Deposit?

Next Steps / Lender Onboarding:

As soon as you submit this enrollment request, one of our Team Members will contact you to discuss potential lender options. You will also be directed to our "Lender Onboarding Agreement". That form will start out by showing you what documents you will need to gather prior to completing the form itself. Once you have those documents in place, you will need to complete the form and get it submitted. PLEASE NOTE: The typical time frame to get fully enrolled with the lenders can be two to three weeks.

Do you understand the Next Steps?

Please click the "Submit" button below. Once we receive this form we will contact you to complete the enrollment process. If you have any questions or concerns, please call (844) 995-4657.