Contact Information

Date of birth *

Address

Street Address *

City

State

Country

Postal code

Employment Information

Housing

Banking Information

Your debit card will be used to set up your monthly payments, and will be charged the 30%-50% down payment due. Icare adds a 15% admin fee to your payment plan.

Account Number *

Your Loan Options: Please enter how much money you are needing for your procedure. Then calculate what your down payment will be today. Your debit card will be charged the full amount of your down payment today. Please make sure you have funds in your account to avoid penalty or overdraft fees.

How Many Payments? *

24 Payments (30% Down Payment Due Now)

36 Payments (50% Down Payment Due Now)

Down Payment Required *

I understand and agree that by submitting this application, I authorize Innovations Medical (or its financing partner) to charge the debit card or bank account provided for the full 30%/50% down payment immediately. I confirm that the information I have entered is accurate, and I consent to this charge as a condition of approval for my medical financing request. This is non refundable.

2nd Warning *

Once again, I understand that by accepting this agreement, I acknowledge that my DEBIT card will be charged immediately for the corresponding down payment which I chose above (30-50%). If I do not have the funds available, penalty fees may be added to my loan. Once I press the green "Submit Application to Innovations Medical" button below, my card will be charged.

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