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Deferred Payment Form

Account Number or Last 4 SSN

Member Name

First Name

Last Name

Phone Number

(###)

###

####

Email

Are you out of work?

Who is your employer?

Do you have any other household income?

Which type of loan(s) would you like to skip?

Please give us any additional information about your current financial situation.

Once this form is reviewed, someone will contact you to give you further instructions. Please be advised, there is not a fee to skip your loan(s). Interest will continue to accrue until the payment is made. If you would like to continue paying the interest, please contact the credit union whenever you would like to pay. It's not required, but it is an option.