HEALTHCARE FACILITY ACQUISITION LOAN APPLICATION
Enter all amounts in $ USD.

This form is for the purchase and acquisition of any type of healthcare facility.

COMPLETE APPLICATION IN DETAIL:
Submissions that state "See Attached" or provide incomplete information will be considered invalid and will not be processed.
  • Enter all amounts in USD $ Only
  • Down Payment
  • QUESTIONS PERTAINING TO THE HEALTHCARE FACILITY TO BE ACQUIRED

  • City/Town
    State/Region
    Country
  • (Services offered, etc.)
  • No Fault
    From Medicare
    From Medicaid
    From Commercial Carriers
  • furniture and telephone/computer equipment is not acceptable collateral
  • Optional File Upload

    Questions above must be answered as requested.
    Any questions stating "see attached" will not be given consideration and applicant will be required to re-submit the application.
  • Signature

  • Referral Information (if applicable)

  • Account Executive (if applicable)