Required Documents
6 Degrees FSG Patient Financing Program
Name of Practice...
Contact
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Bank Statement 1
Bank Statement 2
Voided Company Check
Doctor's Practice License...
If You Are Also Applying For Merchant Services, Please Upload Your 2 Most Recent Statements
Merchant Statement 1
Merchant Statement 2
Comments...
Submit
Should be Empty: