Lightning Capital Application Shop Name Shop Phone Shop Owner Shop Fax Shop Address Shop Email Lightning Capital Application Business Structure Type? Select Type Individual Corporation S Corporation LLC Operating as a DBA Yes No Shop Owner SSN What is the name of the parent company? Is the SSN above the same as the Shop Tax ID? Yes No Shop Tax ID Lightning Capital Application Check the services your shop offers. Windshield Repair Windshield Replacement In Shop Service Recalibrations Primary Service Locations Mobile Service Range Lightning Capital Application Are You Registered with Safelite? Yes No *If you do not know your Safelite Username and Password that’s okay! Just leave the fields blank and continue onward with the application. Shop ID Safelite Username Are you an Affiliate (Preferred) Safelite shop? Yes No Safelite Password Do you have Safelite EDI capabilities? Yes No Does your shop bypass the networks and bill insurance companies directly? Yes No Parent ID Lightning Capital Application Are You Registered with Lynx? Yes No Lynx Username Please fill out your Linx login information to the right if you happen to know it. If not, leave the fields blank and simply continue by submitting the application. Lynx Password Submit Lightning Capital Application Shop Name Shop Owner Shop Email Shop Phone Shop Fax Shop Address Lightning Capital Application Business Structure Type? Select Type Individual Corporation S Corporation LLC Shop Owner SSN Is the SSN above the same as the Shop Tax ID? Yes No Shop Tax ID Operating as a DBA Yes No What is the name of the parent company? Lightning Capital Application Check the services your shop offers. Windshield Repair Windshield Replacement In Shop Service Recalibrations Mobile Service Range Primary Service Locations Lightning Capital Application Are You Registered with Safelite? Yes No Shop ID Are you an Affiliate (Preferred) Safelite shop? Yes No Do you have Safelite EDI capabilities? Yes No Parent ID *If you do not know your Safelite Username and Password that’s okay! Just leave the fields blank and continue onward with the application. Safelite Username Safelite Password Does your shop bypass the networks and bill insurance companies directly? Yes No Lightning Capital Application Are You Registered with Lynx? Yes No Please fill out your Linx login information to the right if you happen to know it. If not, leave the fields blank and simply continue by submitting the application. Lynx Username Lynx Password Submit
