Gateway Dentistry Group - Financing Application Form
Dr. Disha Nagpal, Dr. Fojan Talei, Dr. Jeff Falk, Dr. Michelle Bazinet, Dr. Sam Tsai
#201 11002 104 Avenue, Grande Prairie, AB T8V 7W5
Fill out our secure online form below or use our printable PDF form that you can complete and fax or mail to us.
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Medicard is Canada's premier medical financing company, and we are proud to be partnered with Gateway Dentistry Group.
Please complete the form below to be one step closer to a new you. Go ahead ... Now you can afford to!
Financing Application Form
Terms & conditions
I/we understand that the above information (the "Collected Information") is being collected for the purpose of obtaining credit from iFinance Canada Inc. and is warranted to be true and complete. I/we hereby authorize and consent to the collection of the Collected Information and to the making by iFinance Canada Inc., its successors and assigns of whatever credit investigations and/or employment and income confirmations iFinance Canada Inc. or its successors and assigns may deem appropriate from time to time, and to the disclosure, sharing or exchange of the Collected Information and any report or information based thereon for these purposes with credit reporting agencies, and amongst iFinance Canada Inc., its successors and assigns or any company with whom I/we have or propose to have a financial relationship.
I/we accept this as written notice of iFinance Canada Inc., its affiliates, service providers and professional advisors (collectively iFinance Canada Inc.) receiving, disclosing, exchanging and using any Collected Information and any other personal information (collectively the "Personal Information") about me/us for the purposes set out below.
iFinance Canada Inc., its affiliates and service providers may use any Information relating to me/us:
- to establish, maintain and administer my/our Financing;
- to determine my/our eligibility for products, goods and services offered by iFinance Canada Inc. including monitoring my/our purchase history as well as evaluating my/our credit standing;
- to determine the suitability of benefits, services or enhancements, and/or which other product or service offers may be of interest to me/us;
- to promote and market additional products, goods and services offered by iFinance Canada Inc. including by means of direct marketing, &
- to comply with legal and regulatory requirements.
I/we hereby also authorize any person who is contacted in this regard to provide such information.
I/we acknowledge that my/our consent to "Use of Personal Information" includes:
- iFinance Canada Inc. providing the service provider who accepts the financing for which I/we am applying (the "Retailer") with iFinance Canada Inc.'s decision with respect to this application and if my/our Card application is accepted, my/our Account number and any other information which the Retailer may reasonably require;
- The Retailer providing iFinance Canada Inc. with information related to any loyalty or reward program offered by that retailer where such loyalty or reward programs is administered by iFinance Canada Inc. and iFinance Canada Inc.'s receipt, exchange and use of such information.
Credit will be extended by iFinance Canada Inc. upon approval of this application and I/we request an account card be issued to me/us and any renewal or replacements thereof. All information provided by me/us in connection with this application is true, accurate and complete in all respects. All information provided by me/us in connection with this application is true, accurate and complete in all respects.
I/we consent to the creation of a Personal Information file containing credit and other personal information. Only those employees of iFinance Canada Inc. whose job functions involve assessment of creditworthiness, credit applications, monitoring, processing of payments and matters relating to the purpose of the file, will have access to my/our file.
I/we understand I/we can tell you to stop using Personal Information about me/us in order to promote and market additional products, goods and services offered by iFinance Canada Inc. I agree that my/our Social Insurance Number may be used as an aid to identify me/us with credit bureaus and others for credit history file matching and other administrative purposes.
I/we also consent to the retention of Personal Information about me/us for as long as is needed for the purposes described above, even after I/we cease to be a customer. In order to ensure the accuracy, completeness and integrity of the credit reporting system, I/we specifically consent to the continued disclosure of my/our Personal Information to credit bureaus even after the loan or credit facility has been retired.