Skip A Payment Form

Step 2

Please complete the form below and agree to the terms listed at the bottom.

Borrower Name *

First Name

Last Name

Account Number *

Modification Agreement

You agree to amend the terms of your original agreement and;

to repay the entire loan balance amount of *

plus the interest at (percentage) *

by paying (dollar amount) each month of *

on the date of *

YYYY

using the collateral of *

By entering your FULL NAME below, you authorize HSM Federal Credit Union to extend your final loan payment by one month. Interest will continue to accumulate on your loan during the month you skip your payment. Payments made through Payroll Deduction will continue to be deposited into your Loan Reserve account for the month you are skipping your payment. Each member is allowed to skip a monthly payment only once per rolling 12 month period and must be current on the loan.

Required *

I agree to all terms.

Type Name as Proof of Signature *

First Name

Last Name