INDEPENDENT ORIGINATOR APPLICATION

Apply to become a Locker Lending Affiliate

Submit opportunities through a private workspace. Scott Locker retains lender selection, pricing, underwriting decisions, and final approval.

Contact and business

Legal nameEmailPhoneHome or business addressBusiness / entity nameEntity formation stateWebsiteYears of lending experienceExpected monthly deal volumeStates where you plan to originateNMLS ID, if applicableLicenses held, if applicable

Products and backgroundProfessional referencesRegulatory, criminal, civil, bankruptcy, or disciplinary disclosuresConflicts or lender restrictions

Required documents

PDF, JPG, or PNG. Tax ID and license details are kept out of routine CRM screens.

Signed Form W-9Driver license — frontDriver license — backEntity document (optional)License evidence (if applicable)E&O insurance (optional)

CertificationsI certify that this application and its documents are accurate and complete.I authorize Locker Lending to verify my identity, business, licenses, and professional background for onboarding.I will protect borrower information and use only approved Locker Lending systems.

Submitting does not create an agency, employment, approval, compensation right, or authority to quote or commit Locker Lending.