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Terms & Conditions: For compliance purposes, you are required to read and accept the following disclosure so we can submit your application for approval. You understand that by marking the I AGREE box and signing below, you are providing ‘written instructions’ to FundMyDr.com under the Fair Credit Reporting Act authorizing FundMyDr.com to obtain information from your personal credit profile. You authorize FundMyDr.com to obtain such information solely to evaluate your application in order to acquire a loan. By submitting this application, I(We) have verified that all information submitted on this application is true and correct to the best of our knowledge, as well as allowing FundMyDr.com, and/or its Lender(s) and other 3rd Parties to verify the enclosed information, including, but not limited to, obtaining our credit reports, contacting our employers to verify employment and income, and/or contacting our Physician to verify the type of procedure(s), procedure date, deposit amount, procedure amount, and remit payment upon approval. If approved for a revolving account, a credit card may be issued in either the Applicant or Additional Applicant's names only, and it will be sent to the home address on the application. APR will vary depending upon credit ratings and/or payment terms that are approved. Credit approvals are valid for a limited time only. Certain fees may apply. By signing, I(We) certify that I(We) have read, agree to, and understand the disclosures herein and I(We) agree to the terms of this application and that a physician staff member may apply on our behalf. If approved for an installment loan account, both the Applicant and Additional Applicant will have full responsibility for the account repayment. If approved for a revolving credit account, any Applicant or Additional Applicant will be the sole cardholder of the revolving credit account and will have full responsibility for the account repayment. Any Additional Applicants will be required to confirm acceptance of the above disclosure prior to submission of this application for consideration.

I (We) certify that I (We) have read, and agree to, and understand the disclosures herein and I(We) agree to the terms of this application I Agree