Tijuana Dentists

 

Formas de Pago

Aceptamos Seguros Dentales Americanos Previa verificacion.
Seguros Dentales de Estados Unidos 
Si! aceptamos Seguros Dentales, el primer paso es que usted se comunique con su compania aseguradora, verifique que su plan tenga cobertura Dental en Tijuana, Baja Calif. Mexico. Si su plan cubre en Mexico, el tramite se lleva a cabo con la compania tramitadora de seguros que se encargan de todo el papeleo.

En su Tarjeta de afiliacion encontrara el numero telefonico donde le pueden proveer informacion sobre su plan dental asi como la cobertura de servicios.  

Insurance Programs & Plans - http://www.dental-resources.com/insure2.html

FINANCING

To apply, please answer each question, unless marked optional. If there is a co-applicant, you must provide all co-applicant information, in addition to applicant information.

IMPORTANT: You will see the terms and conditions at the end of this page. You MUST approve the terms and conditions for the application to be complete. If you have not clicked 'YES' on the terms and conditions section, you have not completed the application. Please follow the directions carefully as you go through the process. Thank you for applying!

 

Applicant Information
First Name: *
Middle Name:
Last Name:
Email : *
Adress:
City:
State:
Zip:
Phone Number:
Date of Birth:
SSN:
Drivers Lic. #:
Expires:
Applicant Employer Information:
Employer :
Occupation:
Phone Number:
Email :
Gross Salary:   monthly
Employment Length:   years           months
Additional Information :
Home Information :

Length at Residence :   years           months
Monthly Payment :
Other Income :
Nearest Relative not living with you and not the Co-Applicant:
(if any)
First Name:
Middle Name:
Last Name:
Relationship :
Phone:
Co-Applicant Information : (if applicable)
First Name:
Middle Name:
Last Name:
Adress:
City:
State:
Zip:
Phone Number:
Date of Birth:
SSN:
Drivers Lic. #:
Expires:
Co-Applicant Employer Information:
Employer :
Occupation:
Phone Number:
Email :
Gross Salary:   monthly
Employment Length:   years           months
Additional Information :
Home Information :

Length at Residence :   years          months
Monthly Payment :
Other Income :
Nearest Relative not living with you and not the Co-Applicant:
(if any)
First Name:
Middle Name:
Last Name:
Relationship :
Phone:
Procedure Information :
Type of Procedure:
Doctor:
Phone Number:
Amount Requested :
Terms and Conditions :
All the information on this form is complete, correct and provided to Trust Dental Care's Financial Institution to obtain an installment loan or credit loan. I/we authorize Trust Dental Care's Financial Institution to investigate credit and employment history and to report the credit experience of any party or authorized user to consumer reporting agencies and others. I/we understand that Trust Dental Care's Financial Institution will retain this application whether or not it is approved. I/we understand that if the application is for a secured loan by real property that additional information is required. I/we certify that I am/we are 18 years or older and have completed the application questions accurately at any time after this application and/or during my/our relationship with Trust Dental Care's Financial Institution. I/we authorize Trust Dental Care's Financial Institution to obtain information concerning my/our employment and credit standing and authorize my/our employer, banks and/or other listed references to release information to Trust Dental Care's Financial Institution. Trust Dental Care's Financial Institution may review from time to time my/our eligibility for any credit extended on the account and may provide information about me/us to others. If I/we designate other authorized users, credit bureaus may receive account information on the authorized users in each users name. I/we agree to notify Trust Dental Care's Financial Institution immediately upon any material change in the information I/we provided herein.

I/we affirm that each of the answers given to the foregoing questions is true and correct and that the foregoing is a true and correct statement of my/our financial condition. It is a federal criminal offense to knowingly make any false statement or report, or to willfully overvalue any property for the purpose of influencing Trust Dental Care's Financial Institution to act on this application.

I/we understand and agree to the terms and conditions of this application:   

YES NO

 
 

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