subject_line
Enrollment Application
Organization Name
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Are you a decision maker pertaining to lead generation?
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Yes
No
How Many Employees are in your company?
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What type of leads are you looking for?
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B2B Intent-Based Leads
Email Marketing Campaigns
Content Syndication
Other:
Other:
What are your target industry..?
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What type of leads are you looking for?
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North America
EMEA
APAC
LATAM
Global
Other:
Other:
What’s your biggest challenge with lead generation currently?
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Which is your favorite chocolate..? As you have reach till here— I want to treat you with that when we meet.
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How many leads are you looking to generate per month?
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Monthly Budget Range You're Looking At
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Below $500
$500 – $1000
$1000 – $3000
$3000+
How soon you want to implement the project?
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less then a Month
1-3 Months
3-6 Months
Other:
Other:
Phone / WhatsApp
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Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Federal Employer Identification Number (FEIN)
Description of Services
Entity 2
Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Federal Employer Identification Number (FEIN)
Description of Services
Please describe all business services offered by your business (This should include any service related or non-related to your Debt Settlement Business)
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0/200 characters
Business Ownership Details
Owner 1
First Name
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Last Name
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Email Address
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Office Phone Number
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Ownership %
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Owner 2
First Name
Last Name
Email Address
Office Phone Number
Ownership %
Owner 3
First Name
Last Name
Email Address
Office Phone Number
Ownership %
Owner 4
First Name
Last Name
Email Address
Office Phone Number
About Your Business
Ownership %
What vendor do you use to setup client special purpose accounts?
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Who is your outside counsel?
First Name
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Last Name
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Phone Number
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Email Address
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List all your active websites
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How do you advertise? (check all that apply)
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TV
Print
Direct Mail
Radio
Internet
Other
Other
Do you claim exemption from state law requirements?
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Yes
No
Please explain
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Average number of new clients enrolled per month (YTD)
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Average debt amount per new client (YTD)
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What is the total outstanding debt enrolled in your program?
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Currently, how many clients do you have enrolled in your program?
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Does your company negotiate the debts?
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Yes
No
Do you outsource your negotiations?
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Yes
No
To whom?
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Do you collect advanced fees from clients?
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Yes
No
Please describe how you acquire new customers. (Be sure to describe all channels or referral partners used to acquire leads)
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If you have partners that refer leads to you, do you pay for those leads?
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Do you solicit or cold call Consumers?
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Yes
No
How do you get the list of consumers to solicit?
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Please describe your overall growth plans for the next 2-3 years (For example, if you plan to expand your coverage to new states, grow your physical presence, or expand your offerings to Consumers, please list that here)
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What phone system do you use?
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Does it have call recording capability?
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Yes
No
Which business models do you use?
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Attorney Model
Advanced Fee Model
Performance-Based Model
Non-Profit Model
Other
Other
Where Do You Do Business?
Please select "N/A" if you do not do business in a state
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I do business in
Licensed
Exempt
N/A
Alabama
I do business in
Licensed
Exempt
N/A
Alaska
I do business in
Licensed
Exempt
N/A
Arizona
I do business in
Licensed
Exempt
N/A
Arkansas
I do business in
Licensed
Exempt
N/A
California
I do business in
Licensed
Exempt
N/A
Colorado
I do business in
Licensed
Exempt
N/A
Connecticut
I do business in
Licensed
Exempt
N/A
Delaware
I do business in
Licensed
Exempt
N/A
Florida
I do business in
Licensed
Exempt
N/A
Georgia
I do business in
Licensed
Exempt
N/A
Hawaii
I do business in
Licensed
Exempt
N/A
Idaho
I do business in
Licensed
Exempt
N/A
Illinois
I do business in
Licensed
Exempt
N/A
Indiana
I do business in
Licensed
Exempt
N/A
Iowa
I do business in
Licensed
Exempt
N/A
Kansas
I do business in
Licensed
Exempt
N/A
Kentucky
I do business in
Licensed
Exempt
N/A
Louisiana
I do business in
Licensed
Exempt
N/A
Maine
I do business in
Licensed
Exempt
N/A
Maryland
I do business in
Licensed
Exempt
N/A
Massachusetts
I do business in
Licensed
Exempt
N/A
Michigan
I do business in
Licensed
Exempt
N/A
Minnesota
I do business in
Licensed
Exempt
N/A
Mississippi
I do business in
Licensed
Exempt
N/A
Missouri
I do business in
Licensed
Exempt
N/A
Montana
I do business in
Licensed
Exempt
N/A
Nebraska
I do business in
Licensed
Exempt
N/A
Nevada
I do business in
Licensed
Exempt
N/A
New Hampshire
I do business in
Licensed
Exempt
N/A
New Jersey
I do business in
Licensed
Exempt
N/A
New Mexico
I do business in
Licensed
Exempt
N/A
New York
I do business in
Licensed
Exempt
N/A
North Carolina
I do business in
Licensed
Exempt
N/A
North Dakota
I do business in
Licensed
Exempt
N/A
Ohio
I do business in
Licensed
Exempt
N/A
Oklahoma
I do business in
Licensed
Exempt
N/A
Oregon
I do business in
Licensed
Exempt
N/A
Pennsylvania
I do business in
Licensed
Exempt
N/A
Rhode Island
I do business in
Licensed
Exempt
N/A
South Carolina
I do business in
Licensed
Exempt
N/A
South Dakota
I do business in
Licensed
Exempt
N/A
Tennessee
I do business in
Licensed
Exempt
N/A
Texas
I do business in
Licensed
Exempt
N/A
Utah
I do business in
Licensed
Exempt
N/A
Vermont
I do business in
Licensed
Exempt
N/A
Virginia
I do business in
Licensed
Exempt
N/A
Washington
I do business in
Licensed
Exempt
N/A
West Virginia
I do business in
Licensed
Exempt
N/A
Wisconsin
I do business in
Licensed
Exempt
N/A
Wyoming
I do business in
Licensed
Exempt
N/A
Washington DC
I do business in
Licensed
Exempt
N/A
List your fees to the client (if you charge different fees per state, please list them out clearly)
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Organization Overview
Do you have a Compliance Officer?
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Yes
No
Who has responsibility in your organization for Compliance?
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Do you plan on hiring a Compliance Officer as a result of offering this product?
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Yes
No
Please list any and all active or settled litigation in the last 3 years (Civil or Criminal) or enforcement actions against your company (Enforcement actions can be from a state or federal regulator, state AG, or DOJ)
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Has company, including the principal(s) and controlling person(s) of the entity with 10% or more ownership interest in the entity, ever been subject to enforcement action (including investigation, inquiry, revocation of license, settlement, or lawsuit) by a state or federal government agency?
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Yes
No
Has company, including the principal(s) and controlling person(s) of the entity with 10% or more ownership interest in the entity, ever been subject to material litigation alleging consumer fraud or noncompliance with consumer protection laws?
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Yes
No
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I CERTIFY THAT THE INFORMATION SUPPLIED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND I GIVE LENDINGUSA, LLC AND THEIR ASSIGNS THE RIGHT TO INVESTIGATE CREDIT AND TO VERIFY THE INFORMATION CONTAINED IN THE APPLICATION.
Title
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Full Name
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Signature
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clear
Code of Conduct
DSC Merchant shall comply with all federal and state laws regulating credit advocacy and debt relief services, including, but not limited to, the 2010 FTC Rules for debt relief providers.
The FTC Rules, among other things, only permit fees to be charged after:
A written agreement is entered with a consumer;
A settlement or result is obtained; and
The consumer authorizes and accepts such result.
Any DSC that is charging Advance Fees for debt relief services will not be eligible for enrollment in LUSA’s DSC Merchant Program.
Communications with clients and the public shall be honest and truthful.
Agreements and services shall be conducted in good faith.
DSC Merchants shall advocate solely on behalf of the client and shall not accept compensation, fair share, contributions or donations from creditors.
Fees charged for services provided to clients shall be fair and reasonable.
Representations regarding the services and potential outcomes of the service that DSC Merchant provides to consumers shall be fair and accurate.
Estimates used in setting up a program for consumers such as the total cost and program length shall be based on historical and substantiated data.
DSC Merchants shall clearly and conspicuously disclose both the risks as well as the benefits of credit advocacy to individuals enrolling in programs.
DSC Merchants shall clearly and conspicuously explain what fees are charged for their services, how the fees are charged and when such fees are earned.
DSC Merchants shall protect the privacy of personal information of clients and prospective clients.
In addition to the above, DSC Merchants shall abide by the rules and program guidelines contained in LUSA’s DSC Merchant Program.
On behalf of the below listed DSC Merchant, i affirm that we commit to the above Code of Conduct for the DSC Merchant’s actions and conduct in the operation of our company.
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I understand that a violation of the code of conduct is grounds for suspension or expulsion from the LUSA DSC Merchant Program.