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Our LAP- BAND Surgery Packages
EVEN IF YOU HAVE POOR CREDIT..WE ACCEPT CO-SIGNERS!
Interest rate and payments plans varies based upon credit score and approval.
We also have a pre-pay program to suit any budget with zero interest.
This pre-pay has helped many get the surgery who could not get financing.
Several clients that did qualify for financing still took the pre-pay option because they were able to save thousands of dollars in interest and fees.
With the pre-pay program there are no late fees, no minimum payment, no penalties you simply pay before you go for surgery. Think of it as a layaway the best part of the pre-pay program is that you can even secure the
sale price for up to 90 days!

Apply for Fiancing
All information is Confidential- You will be notified by email or by phone upon determination
If you are denined Mylbs has a Pre-Pay Option with Zero Interest that several clients chosen to use
to obtain the surgical procedure.
Ask us about how you can apply for this option if you are turned down for any reason or
if you cannot get a co-signer for a line of credit.
YOU WILL BE GLAD YOU DID!

Your credit card will not be billed with this form. Upon completing this form our financial managers will contact you and go over your options with you to see what will work best for your budget.
Every field is required in this application
All fields are required to process your application
Check One Only :
Are You The Borrower?
 
  Are You The Co-Signer?  
If you are the Co Signer, please type the patients full name below that your co signing for:
Patients Full Name:
Title
First Name
Middle
Last
(DOB)
S. S. # Number
Email:
Address:
Address 2
City
State
Zip Code
Phone
Including Area Code
Cell:
Best time to call:
This is?
Type of Loan?
Date of Surgery?
Loan Amount?
Monthly - Annual Income
Monthly Annual
Additional Income?
Rent/Mortgage Amount $
Click One
Rent Own Other
How long at current address
Employer's Name
Years Employed
Positon
Business Phone
Credit Card Check
Card Number

Please Type in Your Full Name Initial to Agree with Disclaimer
By electronically signing, I represent that I am at least 18 years of age and that the information I have supplied on this application is true and correct. I agree that I am applying for a Medical Line Account, provided by MyLapBandSurgery.Com and the four different credit institutions they use for the purposes of financing surgical procedures they offer. This is to be considered after approval for the procedures and does not guarantee any loans this applications is solely for the purposes of getting the best possible rates available according my credit scoring and/or for personal, family or household use. I agree that a credit report may be obtained and used in making the credit granting decision. I agree to be bound by the terms and disclaimer of MyLapBandSurgery.Com and the terms by the Credit Card Agreement that I will receive upon approval.

Only hit the "Submit" 1 time.  You will be taken back to the home page after submission.
Once Your Application is processed you will be contacted by email or by phone with the determination.


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Lapband Lap Band Surgery Cost of Procedure
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