Dear Applicant, Proceed Finance loans are funded by Security First Bank, a Nebraska state-chartered bank. Please read and acknowledge the following:First Name*Last Name*Email AddressEnter your email address if you'd like a copy of this waiver sent to you. Email Use*The Proceed Finance Program requires a unique email address as a means to establish an account. You must own this account and be able to access emails on your own device such as a home computer, iPad or mobile phone. Never share your email password with anyone. I Agree Credit Authorization*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. I Agree Patriot Act*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 you to provide your driver's license or other identifying documents. I Agree Electronic Signature*By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.Recipient Email Address*Where should we send this waiver? This iframe contains the logic required to handle Ajax powered Gravity Forms.