Practice Details:
*Required Fields
* Practice Type:
Select Practice Type
Dental Practice
Veterinary Practice
Optometry Practice
Pharmacy Practice
Medical Practice
Funeral Home
* Purpose:
Select Purpose
Practice Acquisition
Practice Debt Consolidation/Refi
Practice Relocation, Expansion, Remodel
Practice Start-Up
Real Estate Financing
Working Capital
Equipment Financing/Leasing
* Requested Loan Amount:
Select Amount
$100,000 to $200,000
$200,000 to $300,000
$300,000 to $400,000
$400,000 to $500,000
$500,000 to $600,000
$600,000 to $700,000
$700,000 to $800,000
$800,000 to $900,000
$900,000 to $1 million
$1 million to $2 million
$2 million to $3 million
$3 million to $5 million
$5 million to $8 million
$8 million to $20 million
* Practice/Property Value:
Select Amount
$100,000 to $200,000
$200,000 to $300,000
$300,000 to $400,000
$400,000 to $500,000
$500,000 to $600,000
$600,000 to $700,000
$700,000 to $800,000
$800,000 to $900,000
$900,000 to $1 million
$1 million to $2 million
$2 million to $3 million
$3 million to $5 million
$5 million to $8 million
$8 million to $20 million
* Practice State:
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Deleware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Physician/Practitioner Information:
* First Name:
* Last Name:
Address:
City:
State:
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip:
* Credit Score:
Estimated Practice Debt:
Contact Information:
* Best Time To Call You:
Choose a Time
Contact Immediately
Contact Morning
Contact Afternoon
Contact Evening
* Phone Number:
* Email Address:
