ONLINE APPLICATION FOR BLUEBERRY HEALTHCARE FINANCE LLC PROGRAM

Comodo SSL Seal If you wish to proceed with this online application, you will be providing your personal information to Blueberry Healthcare Finance LLC.

To apply online, you must:

-Be at least 18 years of age.
-Have a U.S. Social Security Number.
-Have a street, rural route or APO/FPO mailing address(no PO Box addresses)
-Must be a Legal US Resident.

Important Information About Opening an Account: To help the government fight the funding of terrorism and money laundering activities, Federal law requires institutions to obtain, verify and record information that identifies each person who opens and account. What this means for you: When you open an account, we will ask for your name, address, date of birth or other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Blueberry Healthcare Finance LLC utilizes AES-256 bit high-grade encryption


Program tools and estimated figures
Please use the program tool below if patient has questions about payment figures, rates, totals, etc. This offer represents estimated figures.
Loan amount requested* $
Estimated down payment $
Amount financed $
Payment cycle Monthly
Estimated interest rate 29.9%
Finance program term
Estimated payment $
Number of payments
First payment due June 22, 2017

Please fill out the secure application to apply for financing
* = required field
Provider informationSeduction Cosmetic Center (#6339)
First name*
Middle Initial
Last name *
Email address *
Social security number * - -
Street Number *
Street Name*
(no PO Boxes)
Apt/Unit
City *
State *
Postal Code *
Mailing Address (Same as above) Yes  No
Home phone * - -
Cell phone - -
Work phone * - -
Date of birth *
Employer Name (if self-employed, enter name of business)*
Position/Job Title*
Date of Hire *
Job Type Full Time Part Time
Monthly income* $
Additional Income
Other Income Source
Please note, such income need not be revealed if the applicant does not want the creditor to consider it in determining the applicant's creditworthiness.
Are you a legal resident of the US? Yes No
Monthly Mortgage / Rent Own Rent None
Rent/ Mortgage Amount $
No rent Reason
Drivers license
How long with current employer *
Yrs Mos
LIST TWO RELATIVES AND ONE FRIEND NOT LIVING WITH YOU *
Name Phone No. Relationship
* * *

Co-Applicant Information

First name
Middle Initial
Last name
Email address
Social security number - -
Street Number
Street Name
(no PO Boxes)
Apt/Unit
City
State
Mailing Address (Same as above) Yes  No
Postal Code
Home phone - -
Cell phone - -
Work phone - -
Date of birth
Employer Name (if self-employed, enter name of business)
Position/Job Title
Date of Hire
Job Type Full Time Part Time
Monthly income $
Additional Income
Other Income Source
Please note, such income need not be revealed if the applicant does not want the creditor to consider it in determining the applicant's creditworthiness.
Are you a legal resident of the US? Yes No
Monthly Mortgage / Rent Own Rent None
Rent/ Mortgage Amount $
No rent Reason
Drivers license
How long with current employer
Yrs Mos
LIST TWO RELATIVES AND ONE FRIEND NOT LIVING WITH YOU *
Name Phone No. Relationship


Signed * :


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