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CareCredit Financing Agreement

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CareCredit Financing Agreement

Parties

This CareCredit Financing Agreement (the Agreement) is made between the Creditor and the Borrower on the terms set forth below.

Borrower Date of Birth:    Last four digits of SSN:

Transaction Summary

Provider Name:

Total Cost of Services: $    Down Payment: $    Amount Financed: $

Annual Percentage Rate (APR):    Finance Charge: $

Term of Agreement:    Number of Payments:

Periodic Payment Amount: $    First Payment Due Date:    Payment Due Day of Month:

Repayment Terms

Borrower promises to pay Creditor the Amount Financed together with accrued finance charges in accordance with the schedule above. Payments shall be applied to accrued finance charges and principal in the manner prescribed by Creditor. Borrower authorizes Creditor to apply payments in accordance with Creditor's standard allocation policy.

Payment Authorization and Methods

Borrower selects payment method (select all that apply):

Automatic bank debit (ACH) from account below

Recurring charge to debit/credit card on file

Manual payment by check or other approved method

Fees; Late Payments; Returned Payments

If a payment is not received within days of the due date, Borrower will be charged a late fee of $ or of the missed payment, whichever is less. Returned payment fee: $ .

Default; Remedies; Acceleration

Borrower shall be in default if Borrower fails to make any payment when due, becomes insolvent, files for bankruptcy, or otherwise breaches any material obligation under this Agreement. Upon default, Creditor may declare the entire unpaid balance immediately due and payable, impose default interest at the maximum rate permitted by law, and pursue all remedies available at law or in equity, including collection costs and attorneys' fees to the extent permitted by applicable law.

Prepayment; Refunds

Borrower may prepay all or any portion of the unpaid balance at any time without penalty unless otherwise stated above. Any refund due to overpayment will be applied first to outstanding charges and then to principal; any remaining credit balance will be returned to Borrower in accordance with Creditor's policy.

Representations and Warranties

Borrower represents and warrants that the information provided in this Agreement is true and correct, that Borrower has the legal capacity to enter into this Agreement, and that Borrower will notify Creditor of any change in contact or financial information. Borrower authorizes Creditor to verify credit and employment history and obtain such consumer reports as Creditor deems necessary to evaluate or manage this account.

Notices

All notices under this Agreement shall be in writing and delivered to the addresses below (or such other address as either party shall furnish in writing). Notice is effective upon personal delivery or three business days after deposit with a nationally recognized overnight courier or five business days after deposit with the U.S. mail (first-class, postage prepaid).

Privacy and Assignment

Creditor may disclose Borrower's information as required or permitted by law and as necessary to service, enforce, or collect this account. Creditor may assign or transfer this Agreement, in whole or in part, without Borrower's prior consent; upon assignment, the assignee will have all rights of Creditor under this Agreement.

Arbitration; Governing Law

This Agreement shall be governed by the laws of the state indicated in Creditor's notice address, to the extent not preempted by federal law. Any dispute arising out of or relating to this Agreement may, at the election of either party, be resolved by binding arbitration in accordance with applicable law, provided such arbitration clause is enforceable under governing law. Courts retain jurisdiction where arbitration is not available.

Consent and Certifications

By signing below, Borrower certifies that Borrower has received and reviewed the Transaction Summary, agrees to the terms of this Agreement, authorizes Creditor to charge Borrower's chosen payment method for all amounts due under this Agreement, and consents to electronic communication and, if selected, automatic debit/recurring charges. Borrower acknowledges receipt of any required disclosures prior to signing.

Borrower consents to a credit inquiry for purposes of establishing and servicing the account:    Borrower consents to electronic communications and statements:

Borrower (Print Name):

By:

Date:

Creditor Representative (Print Name):

By:

Date:

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What the CareCredit Financing Agreement Covers

The CareCredit Financing Agreement is the consumer credit contract used when a patient elects CareCredit to finance medical, dental, vision, or cosmetic services. It documents the parties, credit amount or line, finance charges (APR), payment schedule, minimum payments, late fees, and events of default. The agreement also records authorizations for billing, electronic communications, and any optional payment processing instructions. Providers, merchants, and the lender use the signed agreement to confirm consent, set up automatic payments, and document disclosures required by consumer finance and health information laws.

Why a Clear, Compliant Agreement Matters

A properly completed CareCredit Financing Agreement protects patient rights, reduces billing disputes, and documents consent for credit and electronic records. It also supports regulatory compliance with ESIGN (15 U.S.C. ch. 96) and state e-signature laws such as UETA where applicable.

Why a Clear, Compliant Agreement Matters

Who Typically Completes and Signs This Agreement

The CareCredit Financing Agreement is completed when a provider offers CareCredit financing at point of care or during scheduling.

  • Provider billing staff — enter patient details, plan terms, and merchant information before sending for signature.
  • Patient or guarantor — reviews financing terms, signs, and selects payment method.
  • Clinic administrators — retain the executed agreement and configure electronic delivery and payment processing.

Accurate completion and a retained signed copy reduce processing delays and support consumer finance disclosure obligations.

Core Elements to Include in a Professional Agreement

A complete CareCredit Financing Agreement contains a standard set of clauses and fields that establish the loan, payment mechanics, protections, and authorizations.

Parties

Full legal names and contact details for borrower, co-borrower (if any), and the merchant or provider responsible for billing and notices.

Credit Terms

Total financed amount or credit line, APR or promotional rate, finance charge calculation, and any deferred interest conditions.

Repayment Schedule

Monthly payment amount, due dates, minimum payment rules, and the number of payments or payoff date.

Fees & Penalties

Late fee amounts, returned-payment fees, interest on late balances, and collection or charge-off procedures.

Authorizations

Electronic signature consent, ACH or card authorization, permission to share data with the lender, and marketing opt-in/opt-out choices.

Default & Remedies

Events constituting default, acceleration rights, repossession or setoff rules (if applicable), and dispute resolution methods.

Step-by-Step: How to Complete the Agreement

Follow these sequential steps to prepare, verify, and execute a CareCredit Financing Agreement reliably.

  • 01
    Collect Information: Gather patient ID, contact, SSN/TIN, service estimate, and the provider's merchant details.
  • 02
    Populate Form: Enter borrower data, credit amount, APR, repayment schedule, and payment authorization fields.
  • 03
    Verify Details: Confirm identity, check dates and amounts, and ensure consumer disclosures are present.
  • 04
    Execute Signature: Send for electronic signature or complete in person; retain the signed copy and audit trail.

Configuring an Online Completion Workflow

Set up a consistent digital workflow so staff can send, track, and archive signed agreements without manual handoffs.

Field Configuration
Signature Method Enable e-signature with audit trail and optional two-factor authentication.
Notifications Auto-notify signers by email and send reminders at configurable intervals.
Authentication Use email link or SMS code for consumer identity verification; KBA only when required.
Document Retention Store completed agreements with versioning and export options (PDF/A recommended).

Typical Execution Flow from Provider to Lender

This flow describes who does what from initial offer to signed agreement delivery.

  • Provider Prepares: Staff enters patient and transaction details and uploads the agreement.
  • Send to Borrower: System generates a secure signing link or in-person signing session.
  • Borrower Signs: Patient reviews terms, consents to e-signature, and signs electronically.
  • Archive & Route: Signed copy and audit log sent to lender, provider billing, and patient records.

Technical and Integration Considerations

Choose a platform that supports required file types, audit trails, and compliance features for consumer finance and health data.

  • File Formats: Accepts PDF, DOCX, and exports to PDF/A
  • Integrations: Connects to EHR, PMS, or CRM systems
  • Authentication: Supports email, SMS, and SSO methods

Typical Timelines and Processing Expectations

Be aware of approval and servicing timeframes so patients receive clear expectations at point of sale.

Application Approval:

Most approvals occur within minutes to 48 hours depending on lender verification.

Funding / Account Activation:

Account ready or credit line available immediately or on the next business day.

First Payment Due:

Check the agreement for the first payment date and grace periods.

Rescission or Cancel Window:

Some plans allow brief cancellation windows; confirm lender disclosure for exact timing.

Record Delivery:

Signed agreement and audit trail typically delivered to parties within 24–72 hours.

Key Milestones from Offer to Closed Account

Track these numbered milestones to monitor completion and follow-up tasks during processing.

01

1. Offer Presented

Patient accepts financing option during scheduling or at point of care.

02

2. Agreement Prepared

Provider completes terms and generates the signing link or paper form.

03

3. Execution and Verification

Borrower signs electronically; identity verification and disclosures are confirmed.

04

4. Account Active

Lender activates credit line and enables payments; provider posts charges to account.

Common Errors That Slow Processing

  • Mismatched legal names or missing SSN/TIN entries that prevent identity verification and credit approval.
  • Incomplete payment authorization details or expired card information that lead to failed first payment attempts.
  • Absent or improperly formatted effective dates that complicate interest calculation or promotional rate timing.
  • Failure to capture explicit electronic consent or deliver required consumer finance disclosures before signing.

Consequences of Incorrect or Missing Information

Late Fees: Assessed per agreement terms
Interest Accrual: Promotional balance may incur interest if terms breached
Charge-Off: Delinquency can result in account charge-off
Credit Reporting: Delinquency may be reported to credit bureaus
Regulatory Penalties: Missing disclosures risk TILA or state penalties
Collection Action: Legal remedies may follow unresolved defaults

Essential Data Elements and Short Format Guide

Borrower Name: Full legal name
Identification: DOB and SSN/TIN
Contact Information: Street, city, state, ZIP
Payment Method: Card or bank last four digits
Provider Info: Merchant name and location
Consent Record: Signed e-consent and timestamp

eSignature Vendor Comparison for Financing Agreements

Common vendor features and starting prices are presented to compare basic capabilities relevant to financing agreement workflows.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Practical Examples of Use

Two common scenarios illustrate how providers and patients complete CareCredit agreements in practice.

Dental Practice Example

A dental office presents financing at treatment planning

  • Patient chooses a promotional 12‑month plan
  • The office sends an e-sign link, captures signatures and ACH authorization, then stores the signed PDF and audit trail for billing.

Optical Clinic Example

An optical retailer offers financing for frames and lenses

  • Patient signs on a tablet at checkout
  • The signed agreement is routed to the lender immediately and integrated with POS to finalize the sale.

Practical Tips for Accurate, Efficient Completion

Apply consistent procedures to reduce rework and support regulatory compliance when handling financing agreements.

Standardize Data Entry
Use templates and required fields to ensure names, addresses, and ID numbers follow a single format; this reduces identity verification failures and lender rejections.
Capture Consent Explicitly
Present a clear ESIGN disclosure and obtain affirmative electronic consent before signing; save the consent record with timestamp and IP.
Use Strong Authentication
Where possible, enable multi-factor or SMS codes for new borrowers to reduce fraud risk and support later attribution of the signature event.
Archive Audit Trails
Store completed agreements plus the audit trail and any verification evidence in tamper-evident PDF/A format to support dispute resolution and audits.

Who Signs and Who Can Bind the Account

Borrower — Patient

The patient or authorized guarantor must sign all financing agreements. If a guarantor co-signs, both signatures are required to bind the lending obligation and permit collections against either party.

Authorized Representative — Billing Manager

A healthcare provider's authorized billing manager may prepare and send the agreement but cannot sign on the patient's behalf unless a valid power of attorney or written authorization is attached.

Authentication, Notarization, and Witness Steps

Follow these steps when notarization or witnesses are required by state law or lender policy.

01

Check Requirement

Confirm whether the lender or state requires notarization or witness signatures before presenting the agreement.

02

Choose Method

Decide between in-person notarization, remote online notarization (RON), or standard e-sign without notary.

03

Verify ID

Obtain government ID and verify identity using the chosen authentication method.

04

Record Consent

Include the ESIGN consumer disclosure and record affirmative consent to electronic records.

05

Execute Signature

Signer executes signature; notary or witness completes their block if required.

06

Record Notarization

If RON used, retain audio-video recording and notary journal per state retention rules.

07

Deliver Copies

Send signed copies and audit trail to lender, provider, and borrower.

08

Store Securely

Archive executed document with tamper-evident storage and access controls.

Frequently Asked Questions and Troubleshooting

Answers to common questions about enforceability, signature problems, and recordkeeping for CareCredit agreements.


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