You understand that you are applying for a loan under the Proceed Finance Program. The Provider Representative may be assisting you in the completion of an online credit application. You are authorizing Med-Den Funding LLC d/b/a Proceed Finance on behalf of Security First Bank, Lender, under the Fair Credit Reporting Act to obtain information from your personal credit profile or other information from the credit bureau and credit reporting agencies. You authorize Med-Den Funding LLC on behalf of Security First Bank, Lender, to obtain such information to confirm your identity and avoid fraudulent transactions in your name.
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.
Prior to 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 Security First Bank to share information with my medical/dental provider(s) concerning the status of this application and account
- Although Proceed Finance and Security First Bank will not be provided with information about my specific treatment(s), I hereby authorize the provider to disclose my name, verify that I am receiving treatment, verify whether the treatment has been completed, and verify the cost of that treatment to Proceed Finance and Security First Bank
- Allow Proceed Finance and Security First Bank to verify the information I have entered on this application, as well as obtain my credit report
- Proceed Finance may need to contact me regarding my application or my relationship with Proceed Finance, its partner banks, the patient’s provider, or other third parties. By submitting this application, I expressly consent to be contacted by Proceed Finance, its agents, representatives, affiliates, or anyone calling on its behalf for those reasons at the mobile or landline telephone number(s) I provide (including any landline telephone number later converted to a mobile telephone number). I understand my mobile telephone provider will charge me according to my plan.