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Skip-a-Payment Form

1) I want to skip my loan payment. I understand there is a processing fee. The processing fee does not reduce the principal or interest owing.

2) I understand that deferring the loan payment will result in an extension of the original term and that interest will continue to accrue at the rate disclosed in my original loan agreement.

3) I can make up the payment at any time, but extra payments will not change the due date of the next scheduled loan payment. I authorize the credit union to change the payment schedule.

4) Provided that I qualify for a Skip-A-Payment, I hereby authorize and instruct the credit union to take whatever actions are necessary to implement the skipped payment which shall include without limitations, stopping any automatic withdrawals/payments/transfers from another financial institution or from any of the accounts at the credit union. I authorize Credit Union to take the steps necessary to reinstate and accept the automatic withdrawals/payments/transfers after the one month skipped payment. I understand that the credit union may not be able to stop the automatic withdrawals/payments/transfers and agree to hold it harmless for failing to do so.

5) The terms and conditions of my loan agreement remain in force.

By submitting the form below, I accept the terms of the Skip-A-Payment program above, and I am requesting a skip on an eligible loan type. I certify that all statements made on the entire form are true and complete to the best of my knowledge, and that I have read and agree to the Electronic Signature Terms.

Personal Information

Account Information

I understand there is a processing fee for this skipped loan payment of $25.00. I authorize payment by a deduction from my Division 10 Share Account # listed below:


All parties to the original loan agreement, including co-borrowers, must sign (enter their names) below:

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