Loan Application

You must be logged in to apply for a new loan. If you already have a user account with Weight Loss Services, Inc then please login above, otherwise, fill out the form below to create a new user account now.

Applicant User Registration

First Name:

Last Name:

Email Address:

Password:

Confirm Password:

Password Requirements:
- Must be between 6 and 16 characters in length.
- Only AlphaNumeric characters. No special characters allowed.
- Must contain at least one letter and one number.