1. Step1Application Info
  2. Step2Plan Selection
  3. Step3Plan Confirmation

See your payment plan options with Carrington Dental Care(Jay Bauer)

Loan Amount and Patient Info
Please enter the amount you need.
Applicant address

Applicant Information

Home Address
Is your mailing address the same as your home address?
Applicant Details

  • Some examples of income include the following:

  • Income from employment, including full-time, part-time, freelance, or seasonal jobs

  • Self-employment, including any business dividends or rental income

  • Any other income such as retirement, social security, or public assistance

  • Important notes:

  • • Non-taxable income, if included, should be increased by 25%.

  • • Alimony, child support or separate maintenance income need not to be included if you do not wish to have it considered as a basis for repaying this obligation.

  • • Married Wisconsin Residents Only: If you are applying for an individual account and your spouse is also a WI resident, combine your and your spouse’s financial information.

Application Disclosures
Call To Action

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, or when you are added to an existing account, we will ask for your name, permanent physical street address, date of birth, and other information, which may include social security number or TIN, that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. You may also be asked to provide such information at other times upon request of the Bank. We will accept a post office box only as a mailing address.