Secure Skip-A-Payment Form

Member Account Number:

First Name(s):

Middle Name/Initial:

Last Name:

Email Address:

Street Address:

City:

State:

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Zip Code:

Home Phone #:

Cell Phone #:

Work Phone #

Ext:

Skip my payment for the month of:

Please take the $25.00 Skip-A-Payment fee from:

I understand there is a $25 fee for each loan payment that is skipped. Check one:

Apply skip payment to all my eligible loans
Apply only on the following loans 
               Loan Description:

My payments are made by:

Payroll deduction Transfer

Deposit my deferred loan payment(s) into my:

Savings Checking

SKIP A PAYMENT POLICY AND AGREEMENT:

You may be eligible to skip your monthly loan payment, provided that all of your accounts at Patriot Credit Union are in good standing and current.

*Your interest will continue to accrue and the skipped payment will cause your loan to extend beyond the original maturity, which will change the total amount and schedule of repayment. All other terms and conditions of the loan will remain unchanged.

If your loan is insured with Credit Life and/or Disability, your monthly premium for coverage will still be added to the loan on the skipped month.

You may take advantage of this offer two times each calendar year, but not in consecutive or back to back months. All parties of the original loan agreement, including any co-borrowers, must sign the Skip A Payment form.

Loans that are not eligible and do not qualify for the Skip A Payment Program:

• Loans with less than a six month payment history
• Loans with an APR(annual percentage rate) that would exceed 18% when the $25 fee is included
• Share secured, Real Estate, Mortgage, and Home Equity Loans
• Delinquent Loans and Accounts not in good standing

*Skip A Payment Agreements must be received at least 10 days before payment is due

I HAVE READ THE ABOVE POLICY AND I WOULD LIKE TO SKIP A PAYMENT. I understand that interest will continue to accrue and the skipped payment(s) will cause my loan to extend beyond it’s expected maturity date.