Required Field *
Account Number*
Loan Number*
Home Phone*
Work Phone*
Cell Phone*
1. Please list which loan payment(s) you wish to skip:
A maximum of two payments can be skipped within a 12 month period. Payments do not have to be skipped in consecutive months.
When requesting to skip a payment on your VISA, refer to "Payment Due Date" on your statement as the month you wish to skip. If your VISA account is over the limit, the over-limit amount must be paid before you can skip the monthly payment.
2. Please check the type of loan payment(s) you wish to skip.
Only loans listed are eligible. Loans must be open at least 90 days to qualify.

3. Read and agree (REQUIRED).
By deferring the payment(s), I understand interest will still be accumulating on the outstanding balance, which will increase the total cost of borrowing and extend the term of the loan. I will resume payments as scheduled following the last month skipped above.
To be eligible for this special offer, all Credit Union accounts must be in good standing. Loans over $60,000.00 not eligible. You will be contacted by mail if we cannot approve your request. If you have any questions, please call our loan department at (513) 559-1234 x 1111.

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