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

• The terms of the Security First Bank Privacy Policy

• 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.