Apply for
Practice Funding.

1. APPLICATION AND AGREEMENT

This application constitutes an offer to obtain business funding from MedicalBizFunding. By submitting this application, the applicant ("Borrower") agrees to be bound by these terms and conditions.

2. ACCURACY OF INFORMATION

Borrower certifies that all information provided in this application is true, accurate, and complete. Borrower acknowledges that any misrepresentation or omission of material facts may result in denial of funding or immediate recall of any funds advanced.

3. AUTHORIZATION TO VERIFY INFORMATION

Borrower authorizes MedicalBizFunding to verify all information provided, including but not limited to credit reports, bank statements, tax returns, financial statements, and references. Borrower authorizes MedicalBizFunding to obtain consumer and business credit reports from one or more credit reporting agencies.

4. CREDIT CHECK AUTHORIZATION

Borrower explicitly authorizes MedicalBizFunding to perform hard and soft credit inquiries on the business and all owners/guarantors listed in this application. This authorization extends to obtaining consumer and/or personal, business and investigative reports from credit bureaus including but not limited to TransUnion, Experian, and Equifax.

5. PERSONAL GUARANTEE

All owners with 20% or more ownership agree to personally guarantee any funding provided. Personal assets may be subject to collection in the event of default. This personal guarantee remains in effect until all obligations under the funding agreement are fully satisfied.

6. ELECTRONIC SIGNATURE

By typing your name in the signature field, you agree to be legally bound by this application and all terms herein. Your electronic signature has the same legal effect as a handwritten signature.

7. REPAYMENT TERMS

If approved, Borrower agrees to repay the funding according to the terms specified in the funding agreement. Repayment may be structured as daily, weekly, or monthly payments depending on the funding product selected.

8. DEFAULT AND COLLECTIONS

In the event of default, MedicalBizFunding may accelerate the full balance, pursue collections, and report to credit bureaus. Borrower is responsible for all collection costs including reasonable attorney fees.

By signing above, each of the above listed businesses and business owner/officer (individually and collectively, "you") authorize (MedicalBizFunding) and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial business loans having daily/weekly repayment features or purchases of future receivables including Revenue-Based Financing transactions, including without limitation the application therefor (collectively, "Transactions") to obtain consumer and/or personal, business and investigative reports and other information, about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties.

You also authorize (MedicalBizFunding) to transmit this Application, with any of the foregoing information submitted/obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to (MedicalBizFunding) and to each of the Recipients, on its own behalf.

You intend to sign this Application electronically and consent to transacting business with (MedicalBizFunding) and its affiliates electronically. You are providing your business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions with (MedicalBizFunding) and/or its affiliates on either medium.

You also hereby consent to the receipt of text messages knowing that msg and data rates may apply and you can STOP messaging by texting back "STOP" at any time. By providing your wireless phone number, you agree to receive calls and text messages from MedicalBizFunding at that number, including autodialed and prerecorded message calls, about your application and related services. Your consent to receive autodialed and prerecorded message calls and text messages is not required in order to obtain credit from MedicalBizFunding.

You understand that any information sharing with third parties is for the purpose of processing your funding application and will be conducted in accordance with our Privacy Policy. All personal and financial information will be kept confidential and used solely for the purposes described herein.