Skip-A-Pay Form

• Open to Members with all accounts in good standing

• Have 9 months of payment history with no late payment

• Form and fee payment sent to the Credit Union 5 days prior to due date of loan

• $35 fee per loan

Date

MM

DD

YYYY

Month to Skip

Name

First Name

Last Name

Daytime Phone Number

(###)

###

####

Email

Account Number

$35 fee will be paid by:

Checking

Savings

Acknowledgment

SIGNATURE AGREEMENT: By submitting this application electronically. I/we agree to the same terms that apply to a signed application. It there is a co-applicant on this loan, that co-applicant has authorized the submission of this application. This electronic submission qualifies as my/our signature.

Signature

Type Your Name

Skip-A-Pay application subject to approval. Only one month may be skipped per loan. All Credit Union loan programs, rates and conditions are subject to change at any time without notice. Interest charges accrue on a daily basis. Skipping a payment extends the term or length of your loan. Not available for Home Equity Loans, Credit Cards or HomePlus Energy Loans. Vehicle loans with GAP coverage are limited to 2 Skip-A-Pay requests per term of the loan.