MODRN Vitality and AestheticsSecure Application

Business Financing Application

Complete the form below to apply. It takes just a few minutes. All fields marked as required must be completed before submitting.

1

Representative & Financing

Who referred you and how much you'd like to finance.

The name of the rep who sent you this link.

Enter the total dollar amount you're requesting.

2

Applicant Information

Personal details for the primary applicant.

Transmitted securely and stored confidentially.

Your total personal income before taxes.

3

Contact Information

How we'll reach you about your application.

4

Business Information

Details about the business being financed.

Approximate gross revenue over the last 12 months.

Typical gross revenue in an average month.

Optional. Upload up to 3 files — PDF or image, max 10 MB each.

5

Additional Details

Professional licensing and co-signer information.

How many years the applicant has held their professional license.

Authorization & Signature

By signing above, I/we authorize lessor and/or debtor and their affiliates, successors, or its designee (and any assignee or potential assignee thereof) to obtain consumer and/or business credit reports relating to my/our credit history and/or creditworthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit for reviewing or collecting the resulting account. By signing below, I/we affirm my/our identity as the respective individual(s) identified in this application and authorize you to contact me/us at any numbers provided above. I/we also certify that all loan proceeds will be used exclusively for business related purposes. If the business is a corporation or partnership, all authorized owners/principals must sign and include their corporate/partnership title. A Photostat or facsimile copy of this authorization shall be valid as the original.

CREDIT RELEASE AUTHORIZATION: I hereby certify that the information contained in this credit application is true and accurate and I/we hereby authorize our banks, trade references, and financial institutions the right to release credit information. In states where permissible, I hereby authorize the filing and recording of UCC financing Statements showing the Secured Party's interest in the equipment and grant the Secured Party the right to execute Lessee's/debtors name thereto. A photostat copy of this authorization shall be as valid as the original. This document may be electronically signed, and any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Draw with your mouse, finger, or stylus.

Type your full legal name as it appears in your signature.

Your information is transmitted securely and used solely to evaluate your financing request. By submitting, you certify the information provided is accurate to the best of your knowledge.