Doctor Loan Information Form

Doctor Financing

                                     (Please Complete All Questions)
Loan Amount Needed:
Purpose of Loan:
Has Loan Been Declined:
Yearly Revenues:
Practice Age:
Legal Name of Practice:
Email Address:
Practice City: 
Practice State: 
Date First Licensed:
Dr. First / Middle / Last Name:
FICO Credit Score:
Credit Score Received From:
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Credit History:
Business Phone No:
Cell Phone No:
Medical Financing
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BRT Financial Inc.
450-106 State Rd. 13N, Suite 408
BRT Financial BBB Rating Jacksonville, FL 32259

Tel: 904. 551. 6090
Fax: 904. 513. 9229