MedMaxFinance.com - PayAssyst Loan Management System

APPLY FOR AN ACCOUNT

Must be at least 18 years of age to apply. We will use a patient's phone number(s), email and/or address to communicate with them about their application and/or account. See "Authorization" section of disclosure for further details.

Step: One

* denotes required field.

General Information

View Terms and Conditions

* UserName:

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* UserNames are case sensitive, must be at least 6 characters long, no unusual characters, and no spaces allowed.

* Password:

*Confirm Password:

* First Name:

Middle Initial:

* Last Name:

*Email Address:

* Birth Date:

* SSN:

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