Submit the application below for terms and information
Need help or have quesetions on this form? Please contact us
info@finservices.com
Office: 800.336.8562 | Fax: 800.987.7713
Total Loan Amount Requested: $
Financing Programs
* Financing Type:
Make Your Selection
Equipment Financing
Working Capital Loan
Equipment & Working Capital
Supply Loan
Debt Consolidation Loan
Implant Financing
Start-Up Practice Financing
Relocation Loan
Practice Acquisition Financing
Purchase a Building Mortgage
Construction Financing for a New Building
Refinance Owner-Occupied Building
Equity Out Practice Loans
Group Preferred Line of Credit
Not sure, contact me
The financing is intended for business or professional use only.
Equipment Description (if applicable):
* Preferred Financing Program: For non-real estate loans
Select Preferred Term In Months
12 Months
24 Months
36 Months
48 Months
60 Months
72 Months
84 Months
Not Sure / Something Else
Not Applicable
Business information
Legal Business Name:
Business Address:
City, State, Zip:
Tax ID Number (Leave blank if not immedately known) :
Business Phone:
Year business established:
Gross Annual Revenue (Last Year):
$
Owner information
Your Name (as it appears on your Drivers License):
Your Ownership %: Include all legal owners with 20% or more ownership
Social Security #:
Date of Birth:
Specialty:
Medical / Dental License Number:
Year Licensed:
Are You A U.S. Citizen:
Do You Own Another Established Business:
Your Home Address:
City, State, Zip:
Mobile Phone:
E-mail:
Add Second Owner Information
Second Owner Name (as it appears on your Drivers License):
Second Owner Ownership %: Include all legal owners with 20% or more ownership
Second Owner Social Security #:
Second Owner Date of Birth:
Specialty:
Second Owner Medical / Dental License Number:
Year Licensed:
Are You A U.S. Citizen:
Do You Own Another Established Business:
Second Owner Home Address:
City, State, Zip:
Second Owner Mobile Phone:
Second Owner E-mail:
Add Third Owner Information
Third Owner Name (as it appears on your Drivers License):
Third Owner Name Ownership %: Include all legal owners with 20% or more ownership
Third Owner Social Security #:
Third Owner Date of Birth:
Specialty:
Third Owner Medical / Dental License Number:
Year Licensed:
Are You A U.S. Citizen:
Do You Own Another Established Business:
Third Owner Home Address:
City, State, Zip:
Third Owner Mobile Phone:
Third Owner E-mail:
Other Information
Supplier Name / Equipment Dealer:
Supplier Contact:
Supplier Contact Phone or Email:
GFS Representative (If Known) :
Additional Information:
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I hereby understand and authorize our banks, consumer agencies, trade references, and financial institutions to compile and furnish any information pertaining to our credit and financial responsibilities as requested by GROUP FINANCIAL SERVICES or its assigns and photostatic,
facsimile, or other electronic copies of this authorization may be submitted to obtain the release of this information.
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