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Patient Financing

I understand that the information I provide is for the purpose of obtaining credit from Credit Medical Corporation and is warranted to be true and complete. I hereby authorize and consent to the receipt and exchange of information about me by Credit Medical Corporation and its affiliates from time to time as Credit Medical Corporation may deem appropriate, including the making by Credit Medical Corporation and its affiliates of whatever credit investigations and/or employment and income references as Credit Medical Corporation may deem appropriate from time to time, and to sharing or exchange of reports and information with credit reporting agencies, or any company with whom I have or may propose to have a financial relationship.