Step 1 Step 2 Step 3 Step 4 Step 5 Start Finish Progress General Information Company Name: Company NMLS: Street Address: City: State: Select... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip: Phone Number: Organization Type: - Select - Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate LLC – C Corp LLC – S Corp LLC – Partnership Other Tax ID: State Company Organized: Select... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Date Founded: Broker of Record Last Name: First Name: SSN: Email: Individual State License #: Owner/Manager Same as Broker: Last Name: First Name: SSN: Email: Loan Origination Agreement Please review and sign the Provident Funding loan origination agreement. You will be asked to upload the executed agreement in step 6 of the sign up process. Loan Origination Agreement Referred by: Select State: Select... Arizona California Colorado Connecticut Florida Georgia Hawaii Idaho Illinois Indiana Kansas Kentucky Massachusetts Maryland Michigan Minnesota Missouri North Carolina New Jersey Nevada Ohio Oklahoma Oregon Pennsylvania South Carolina Tennessee Texas Utah Virginia Washington Wisconsin Please select the preferred state that you wish to receive emailed rate sheets. Login Information Same as Broker: Last Name: First Name: Email: Phone Number: Username: Must have at least 6 alphanumeric (A-Z or 0-9) characters. Password: Password must be at least 8 characters. Must contain at least one lower case letter, one upper case letter, one digit, must not contain the word Provident, must not be equal to username and have at least one of these characters: !@#$-_. Confirm Password: Please select two security questions from the dropdowns below and type in the answer for each question in the corresponding text field. You may be asked to answer the questions you choose in case you need to reset or retrieve your username or password. Security Question 1: Please select... What is the name of your first childhood pet? What was your childhood nickname? In what city did you meet your spouse/significant other? What is the name of your favorite childhood friend? What street did you live on in third grade? What is your oldest sibling's birthday month and year? (e.g., January 1900) What is the middle name of your youngest child? What was the name of your first stuffed animal? What was the color of your first car? What is the first name of the boy or girl that you first kissed? What was the last name of your third grade teacher? What are the last 5 digits of your driver's license number? Where does your nearest sibling live? What is your youngest brother's birthday? What was the name of your elementary / primary school? What is your maternal grandmother's maiden name? In what town was your first job? Answer: Security Question 2: Please select... What is the name of your first childhood pet? What was your childhood nickname? In what city did you meet your spouse/significant other? What is the name of your favorite childhood friend? What street did you live on in third grade? What is your oldest sibling's birthday month and year? (e.g., January 1900) What is the middle name of your youngest child? What was the name of your first stuffed animal? What was the color of your first car? What is the first name of the boy or girl that you first kissed? What was the last name of your third grade teacher? What are the last 5 digits of your driver's license number? Where does your nearest sibling live? What is your youngest brother's birthday? What was the name of your elementary / primary school? What is your maternal grandmother's maiden name? In what town was your first job? Answer: CONTINUE TO STEP 2