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Multi Radiance

Call to order now! In USA and Canada (877) 542.0761 International +1 440.542.0761
 
REQUEST A DEMO Contact Us

To apply for financing through NCMIC for Multi Radiance Medical products, please fill out and submit the application below.

Equipment and Payment Information

Equipment vendor you plan to buy from *
Briefly describe the equipment you wish to finance *
Amount you would like to finance *
Preferred Term Length *
Interested in 90 Day Deferral?

Personal Information

First Name *
Last Name *
Home Address *
Social Security Number *
Professional License Number (or Title) *
Years Licensed (or with current title) *

Business Information

Legal Name of your Business *
Years in business (under current ownership) *
Company Address *
City *
State *
Zip *
Office Phone *
Fax
Email *
Cell *
Annual Practice Gross Revenue (est) *
Annual Personal Net Income (est) *

 

* Multi Radiance Medical will not store your Social Security information from this application and will be sent directly NCMIC electronocally.

 

I hereby authorize the release of business and/or personal credit information to Multi Radiance Medical it's affiliates of assignee (1) from any source including credit bureau reporting agencies and my bank for the purpose of extending credit, and (2) to any credit reporting agency. I hereby represent all information is true, correct and complete. A photo static and/or facsimile copy of this authorization shall be valid as the original. 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 a part of the applicant’s income derives from any public assistance programs, or because the applicant has in good faith exercised any rights under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. To help the Government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. This means that when you apply for credit or open an account we may ask for your name, address, date of birth, social security number, and other information that will allow us to We may also require that you furnish a copy of your Driver’s License or other identifying documents. Consult your attorney or financial advisor for specific legal and/or tax advice before entering into any type of financing arrangement, and for information on tax deduction eligibility and procedures. NCMIC Finance Corporation and the equipment vendor/ broker you selected are separate companies, are not agents of one another and have no authority to bind one another to financial or other contractual obligations.

Digital signature * To agree on the trems as listed above and submit your application to NCMIC, please sign digitally by adding your initials here.
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This website contains information that has not been reviewed or approved by the FDA. Some of the claims and representations of the products contained on this site are cleared by regional regulatory bodies such as CE and Health Canada and may differ from those that are FDA 510K cleared.
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