INSTRUCTIONS FOR CREDIT APPLICATION

1) Fill out the credit application completely
2) Sign and date where indicated on page 2

After completing and signing the application, please return to your dental or other healthcare provider and submit the completed forms where treatment is to be performed, pending credit approval. You will also be required to submit the following:

1) A voided check with routing and account number or a letter from your bank verifying your checking account information including routing and account numbers. Debit and credit cards are not accepted. The account must be a verifiable checking or savings

2) A valid state issued driver’s license or other official government issued photo identification, i.e., passport.

*Your dental or healthcare provider will verify your applications for completeness and accuracy and submit it for credit approval. If you have any questions, please contact your dental or healthcare provider where treatment is to be performed. Compassionate Finance cannot process your application for approval except through direct submission from member practices.