Skip A Pay Application Name Member Account Number Preferred Contact Phone Number Email Address () -Second partThird part Which month do you want to skip your payment? NovemberDecemberJanuary What is the amount of the loan payment on the loan(s) you want to skip? Payment 1 Payment 2 Payment 3 Payment 4 Authorization Agriculture, Business, Commercial, Mortgage, Overdraft Loans and any Loan with an interest rate of 16% are excluded from this offer. All loans must be current to qualify. There may be some circumstances that may prevent approval of this offer. Interest will continue to accumulate on your loan during the month you skip your payment. Your regular monthly payment will resume in the month following the month your payment is skipped. The original maturity date of your loan may be extended. The processing fee of $25 per loan will be deducted from your share/savings or checking account. By signing below you agree to and accept the terms and conditions of the Skip a Payment program and the original terms of your loan agreement. How did you hear about Skip a Pay Take the $25 per loan processing fee from my: WebsiteInternet Tellere-statementsLobbyMessage on HoldOutside Signage Checking AccountShare/Savings Applicant Signature Please type your name below Please enter the security code below prior to submitting the form