Request Financing Application

Ready for financing?

Contact us to learn more

Two easy ways to get started

Choose one of the options below and follow the directions to initiate your application. If you have questions, call 1-888-652-4942 or contact your Practice Finance Specialist.

Request financing information
Credit application

How it works

Complete and submit the form below.
We'll follow up within one to three business days to discuss next steps, including the information necessary to process your application.

Ways to submit an application

Download and complete our Credit Application (PDF)
Send your application to us one of three ways:
- Email: Send directly to your Practice Finance Specialist for expedited service.
- Fax: 1-800-318-8601
- Mail:
  Wells Fargo Practice Finance
  2001 Clayton Road, Suite 900
  Concord, CA 94520
We'll follow up within one to three business days to discuss next steps, including the information necessary to process your application.

Request financing information

All fields are required unless marked as optional.

Contact Information

Error, Enter First Name

First Name

Error, Enter Last Name

Last name

Error, Enter Suffix/Degree

Suffix/Degree (optional)

Error, Enter Street Address

Street Address

Error, Enter City

City

Error, Enter State

State

Error, Enter Zip Code

Zip

Error, Enter Primary Phone Number

Primary Phone

Error, Enter Secondary Phone Number

Secondary Phone (optional)

Error, Enter Fax Number

Fax (optional)

Error, Enter Email Address

Email

Professional Information

Error, Enter Company Name

Company Name (optional)

Error, Enter Your Title

Your Title (optional)

Error, Enter Web Site Address

Web Site Address (optional)

Error, Enter Profession

Profession

Error, Enter License Number

License Number (optional)

Error, Enter Business Structure

Business Structure (optional)

Error, Enter Year Graduated

Year Graduated (optional)

Error, Enter Years You've Been in Practice

Years In Practice (optional)

Error, Enter Years You've Managed a Practice

Years Managed a Practice (optional)

Project Details

Error, Select What You've Interested In

Interested In (optional)

Error, Select Financing Time Frame

Financing Time Frame (optional)

Error, Amount Needed

Amount (optional)

Additional Information

Error, How did you hear about us?

How did you hear about us? (optional)

Error, If other, please describe

If other, please describe (optional)

Error, Select Best Day to Contact You

What is the best day to contact you? (optional)

Error, Select Best Time to Contact You

What is the best time to contact you? (optional)

Error, Please Enter Comments Below

Comments (optional)

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.

All financing is subject to credit approval.