fbpx
0%
Loading Secure Page
Contact Info
198 West 21th Street, Suite 721
New York, NY 10010
youremail@yourdomain.com
+88 (0) 101 0000 000

Sign up now to offer No Credit financing

Provider Location 

Sign Up (Other Industries) (Single Location)

Step 1 : Provider Account Information

Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB
Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB
Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB

Step 2 : Provider ACH Authorization

Remember To "Sign" Our ACH Agreement!
The ACH Form has special button when all required fields are completed .
A blue "Click to Sign" button will appear at the bottom of the ACH page. 
Please make sure you click & sign the agreement using this button before continuing to Step 3! 
 Related image

Complete & sign the following e-document, then scroll down to the bottom of this page to continue to step 2 and complete your sign up.
This form is simply an authorization for us to draft payment after approval. You will not be charged until your account is set up and approved.

*By clicking the "CONTINUE TO STEP 3 OF 3" button, you agree to our Terms & Conditions / Privacy Policy

You’re on your way to seeing more patients!

What do I need to complete Step 1?

1.   Fill out the primary contact information for your office. Include all necessary information, we fund everything and anything in-between.

2.   Make sure to have License information for upload. This information is securely processed by our provider verification team to setup your account.

3.   Click the green button when all required fields are entered. You will be taken to Step 2 which includes provider contact for joining ProtaPay No Credit Financing.