Refer a Provider
A referral is the greatest compliment we can receive.
But let’s get to the real reason…FREE MONEY! That’s right, by referring us to a medical or retail provider, we want to thank you by giving you a $50 VISA CARD*.
Your Information
Your Name
Your Organization (credit union, practice, company)
Phone Number ( ) -
Your Email Address
Confirm Email Address
Special Comments
Your Referral
Person to Contact
Name of practic/company
Profession / type of business
State
City
Contact Type Doctor President Owner Office Manager Hygienist Staff Other
Thank you for trusting us with your neighbors, friends, family, trusted physicians and retail providers.
Here’s how it works….. When we receive your referral, Lifestyle Lending Solutions will contact your referral and verify your name as a contact, patient, customer, or friend. If they sign up on the system….we will send you a *Free $50 VISA CARD. It’s that Easy!
*After a contract is received and after Lifestyle Lending Solutions (LLS) has billed the provider on the 5th of the following month after signing, LLS will send a $50 visa card to the address and name on the referral.
