UPDATED: August 29, 2022

Please read this information carefully and print a copy and/or retain this information electronically for future reference.

You are submitting a request for credit pre-qualification for a participating (or future participating) medical provider (“Application”) from United Medical Credit, Inc. DBA United Credit (“Us”). We can only give you the benefits of our on-line service if you consent to the use or acceptance of electronic signatures and to the use or acceptance of electronic records or disclosures in this transaction (“Your Consent”). By completing and submitting the request for credit pre-qualification on-line, you acknowledge receipt of this document and consent to use electronic signatures and to conduct this transaction by use of electronic disclosures and contract documents (“Records”).

Electronic Communications
You may request a paper copy from Us of any of the Records by writing to Us with the details of your request at: info@unitedcredit.com. Your request for paper copies may be made after Your Consent and after any withdrawal of Your Consent. We will provide the paper copies to you at no charge. We shall retain the Records as required by law.

Consenting to do Business Electronically
Before giving Your Consent, you should consider whether you have the required hardware and software capabilities described below.

Scope of Consent
Your Consent and our agreement to conduct this transaction electronically apply to all notifications, disclosures, and/or documents sent by United Credit. By exercising Your Consent, We will conduct this transaction with you electronically.

Hardware and Software Requirements
To access and retain the Records electronically, you will need to use the following computer software and hardware: An IBM or MAC compatible computer with Internet access and an Internet Browser that meets the following minimum requirements. Microsoft Internet Explorer 6.0 or later versions, Google Chrome, Mozilla Firefox, and (Safari 1.1 for Mac users). Also, the specific Internet Browser must support at least 128-bit encryption. To read some documents, you will need a PDF file reader like Adobe Acrobat Reader. If at any time during this transaction these requirements change in a way that creates a material risk that you may not be able to receive Records electronically, We will notify you of these changes.

Withdrawing Consent
You are free to withdraw Your Consent at any time and at no charge to you. If you do withdraw Your Consent prior to receiving a payment plan from your Merchant, this will prevent you from obtaining a payment plan with Us over the Internet. If at any time you wish to withdraw Your Consent, you can send us your request by email to: info@unitedcredit.com. If you decide to withdraw Your Consent, the legal effectiveness, validity and/or enforceability of prior electronic Records will not be affected.

Change to Your Contact Information
You should keep us informed of any change in your electronic address or mailing address. You may contact Us by e-mail at info@unitedcredit.com regarding any such changes.

Your Ability to Access Records
By typing in your name above, you acknowledge that you can access the records in the designated formats described above.


You acknowledge that you have read the information about electronic signatures and doing business electronically in this consent for electronic records. You consent to using electronic signatures, having all records provided or made available to you in electronic form and to doing business with us electronically. You acknowledge that you may request a paper copy of the records, which we will provide to you at no charge.

Rates & Fees
Please remember that United Credit is not a lender and does not provide lending services directly to consumers. United Credit assists consumers with setting up a payment plan through their medical provider. The Truth in Lending Act requires that all fees and interest rates that you will incur are disclosed if you accept the terms of the payment plan. Thus, all fees and interest rates will be disclosed to you before you are asked to sign the payment plan documents. Please review the fee and rate information provided to you thoroughly and completely before agreeing to the terms of the payment plan. You are under no obligation to accept these terms. If you decide the terms that your medical provider has given to you are acceptable, United Credit will direct you as to how to e-sign for your payment plan. 

The fees and interest rates are determined solely by your merchant or provider, with specific amounts determined based upon the information you submitted. You are under no obligation to continue with the payment plan process if you find these terms are unsuitable.

Applicant age
Due to lender policies the person who is receiving the services is required to be listed as the main applicant if 18 years of age or older. If you believe the person who is receiving the services has non-qualifying credit, an option to add a 2nd applicant is provided at the end of this application. Funding may be canceled or declined if the person receiving the services is over the age of 18 and is not on the application ­(if the person receiving the services is a minor, please list the minor’s legal guardian as the primary applicant).

SMS Terms and Conditions for Application Alerts
The United Credit SMS alert program sends text reminders regarding the status of an applicant’s application throughout the process. United Credit is not responsible for any charges from a person’s service provider that may result from us providing this service. It is the applicants responsibility to check with their individual carrier, as standard messaging and data rates may apply. United Credit assumes no responsibility for charges incurred by our text messaging service.