Member Name

Member Number

Phone

Email Address

Skip All Eligible Loans? Skip All Eligible Loans? I would like to skip a pay for all eligible loans on this account number OR (see below.)

Loan Number

Loan Number

Take fee from account number

Sub account Sub accountSavingsCheckingClub

Electronic Signature (type full name)

Acknowledgement for Skipping a Payment Acknowledgement for Skipping a Payment *I hereby request to defer principal and interest payments on my loan identified below. I understand my next payment will be due on the next regularly scheduled due date in August 2026. By deferring a payment, the total finance charge that you pay on your loan will be greater than what was stated on your loan contract. This and any other previous or future deferments will extend the term of your loan. If you elect to have GAP and/or Credit Disability, Life, or Debt Protection Insurance coverage on the loan and then elect to defer payments using the Skip-A-Payment Plan, your coverage will not cover the entire term of the loan. Excludes mortgages, uniform loans, overdraft lines of credit, home equity loans, home equity lines of credit, Blazing Bucks, or student loans. Loans currently being paid with TruStage payment protection are not eligible. Offer not valid on first loan payment. Credit and other certain restrictions apply. Not all will qualify. Member must not be negative or delinquent. Offer runs 6/1/26 - 6/30/26. $15 fee per member number.