Name of your university and graduation year
Until today, your work history as a dentist:
When and where did you open your first practice? Today where is it?
Do you own or rent the location of your practice?
Total of monthly expenses (Electric, water, telephone, gas, revenues, cleaning, etc.):
Total of your practice’s monthly earnings:
If you have revenue coming from outside your practice, please define what they are and their totals?
List your real estate and personal assets below:
List your private vehicle information:
Guarantor Information:
List real estate and personal assets below:
List their private vehicle information:
*In order for your credit application to be evaluated, because of our company procedures, all the documents that you have submitted will be stored in our records. I confirm and state that the information I have given above is both correct and complete.