Us Medical Funding

2012 Kick-Off Promotion

4.9% Fixed Rate Financing & $500 Cash Back!

For a limited time only, get pre-qualified for your practice financing by February 29, 2012 and commence funding by April 15, 2012 and receive a 4.9% Fixed Rate Practice or Real Estate Loan and $500 Cash Back at Closing. Restrictions: Limited to: (1) the first 50 funded loans, or April 15, 2012 whichever occurs first; (2) transaction type, terms and certain states.; (3) Minimum loan size $275,000. 4.9% Fixed Interest Rate based on February 2012 current cost of funds and may fluctuate slightly on a monthly basis prior to final funding. For a limited time Simply Call 1-800-683-0608 or complete the form below today to get pre-qualified! There is NO obligation NOR any fee associated with this CFQ. Once we have received your profile, your finance specialist will follow up to complete your submission by requesting your social security number, date of birth, and business tax ID # if required. (To protect your privacy, we do not collect this information over the Internet.) You will then receive a completed questionnaire to sign and return for processing. NOTE: All applicable fields must be completed for financing consideration.

Primary Information

First Name *

Last Name *

Suffix/Degree *

Select… CGP DDS DMD DO DVM MD OD RPh VMD

 

 

E-mail *

Confirm: E-mail *

Pro. License #

Year Graduated

Marital Status *

Select… Single Married Divorced Widowed

 

 

Home Street *

Home City *

Home State *

Home ZIP *

Home Phone

Cell Phone

Total Bank Balances

Professional Information

Business Name

Business Phone

Fax

Street

City

State

ZIP

Type of Business

Select… Corporation S Corporation Partnership Sole Proprietorship Limited Liability Corporation (LLC) Limited Liability Partnership (LLP) Professional Limited Liability Corporation (PLLC) Professional Association (PA) Professional Corporation (PC) LTD Non-Profit Publicly Traded None

 

 

Time in Business

Select… Less than 2 years 2 – 5 years 5 – 10 years 10 years +

 

 

Annual Revenue

Select… < $500,000 $500,000 – $1 million $1 – $1.5 Million $1.5 – $2 Million $2 – $5 Million $5 – $10 Million $10 – $20 Million $20 – $50 Million

 

 

Pro. Specialty

Other Related

Interested In

Select… New Start-Up Practice/Business Acquisition Real Estate Acquisition Expansion Improvements Refinance/Debt Consolidation Working Capital/Line of Credit Claims Revenue Acceleration Business Management Solution Improving Cash Flow Condition Other

 

 

Project Amount *

Where did you hear of USMF?

Select… Accounting/Financial Planner Architect/Designer/Contractor Attorney Practice/Business Consultant Current USMF Client Equipment Vendor Internet – Google Internet – MSN Internet – Yahoo Internet – Website Practice/Business Sales Broker Reffered by Colleague Seminar School Tradeshow Conference Post Card Mailer Trade Journal Advertisement Other

 

 

Have you ever filed for Bankruptcy *

Yes

No

Do you have any legal actions against you? *

Yes

No

Do you have any outstanding tax liens? *

Yes

No

Are you involved in any other business or venture? *

Yes

No

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