Borrower Information
Authorization Notice (Phone & Email)
I authorize Proceed Finance, their lending partners, and their representatives, agents, and loan servicers to contact me regarding my loan or my loan request, including repayment of my loan, at the current and any future numbers that I provide for my cellular telephone or other wireless device using an automatic dialing system, prerecorded messages and/or SMS text messages, even if I will be charged by my service provider(s) for receiving such communications.
Income / Housing Expenses
Include only the applicant’s wages, salary, and public assistance or other regular income. Make sure the income provided is verifiable. You may include additional income from the applicant’s spouse or household investments, retirement, or other sources. Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this loan. You should enter only personal income, and NOT any business income.
Patient Information
Patriot Act Notice
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.
Terms of Use
By submitting an application, I agree to and/or confirm that:
The information I have supplied on this application is true and correct
I am at least 18 years old
I am a citizen or permanent resident of the United States
I have a United States Social Security Number
I permit Proceed Finance and its Lender Partners to share information with my medical/dental provider(s) concerning the status of this application and account
I authorize Proceed Finance and its Lender Partners to receive information from my medical/dental provider(s) regarding my name, verify that I am receiving treatment, verify whether the treatment has been completed, and verify the cost of the treatment
I authorize Proceed Finance and its Lender Partners to obtain my consumer credit report and use it in connection with this application, as well as obtain any credit report needed
I understand that my mobile telephone provider will charge me according to my plan
I have read and agree to the E-Consent and have received disclosures electronically
Ohio Residents Only
The Ohio laws against discrimination require that all creditors make credit equally available to all credit-worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with the law.
Wisconsin Married Residents Only
No provision of a marital property agreement, including a Statutory Individual Property Classification Agreement pursuant to Wis. Stat. §766.587 or a unilateral statement under §766.59 or a court decree under §766.70, adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement, or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.
Pre-Qualification Credit Authorization
Upon submission of this form and prior to obtaining any additional information from your personal credit file, we will attempt to match your information with existing prequalified offers under the Proceed Finance program. If you have an existing prequalified offer, we will present that offer in lieu of completing an additional pre-qualification. If you do not have any existing prequalified offers, you understand that you are pre-qualifying for a loan under the Proceed Finance program.
By clicking “Submit” below and submitting this form, you are providing written instructions to Med-Loan Funding LLC d/b/a Proceed Finance and its Lender Partners under the Fair Credit Reporting Act to obtain information from your personal credit profile from credit bureaus and credit reporting agencies for the purpose of pre-qualifying you for a dental loan and to confirm your identity and avoid fraudulent transactions in your name. This may include a soft credit inquiry, which will not affect your credit score.