By submitting this ProMED Application Form, Business Applicant and each Individual (each a “Signer” and collectively “Signers”) represents, acknowledges and agrees as follows: (i) all information provided to Small Business Financial Solutions, LLC, ProMAC Healthcare Financing, LLC and [or] their corporate affiliates (collectively “ProMED”) by Signers is true and complete; (ii) in the event ProMED declines to extend financing to the Business Applicant, Signers authorize ProMED to disclose all information and documents that ProMED may obtain regarding Signers (whether from Signers or third parties) to other persons or entities that are under contract with ProMED for the purpose of providing financing to applicants that ProMED does not provide financing (collectively “Recipients”); and (iii) Signers authorize ProMED and Recipients to:

  1. obtain credit and employment information about the Signers;
  1. obtain credit reports and make any inquiries ProMED and Recipients consider appropriate in connection with this Application or reviews of the Applicant’s account from time to time;
  1. disclose account information as required by law. Each Signer acknowledges that additional information may be required in order to render a decision regarding Business Applicant’s account and Signers hereby certify that they have read and understand the terms of this ProMED Application Form.

SIGNER ACKNOWLEDGES THAT PROMED MAY RELY ON THE STATEMENTS AND INFORMATION SET FORTH IN THIS APPLICATION AND THAT SUCH STATEMENTS AND INFORMATION MAY BE INCORPORATED BY REFERENCE IN ANY AGREEMENT ANY OF THE UNDERSIGNED MAY ENTER INTO WITH PROMED. EACH OF THE UNDERSIGNED HEREBY AGREES TO NOTIFY PROMED PROMPTLY OF ANY CHANGE IN ANY SUCH STATEMENT OR INFORMATION. SIGNER HAS READ AND UNDERSTANDS THE TERMS OF THIS APPLICATION, INCLUDING ANY ADDENDUM, AND REPRESENTS AND WARRANTS THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

If your application for business credit is denied, you have the right to a written statement of the specific reason for denial. To obtain a statement, please contact ProMED Healthcare Financing, 7316 Wisconsin Ave, Suite 350, Bethesda, MD 20814, (240) 514-2000, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

NOTICE:

If applying for a loan, please note that the federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning ProMED is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.