This agreement must be signed by all borrowers, co-borrowers, and/or cosigners.

*Please note that Loans past due more than 30 days are not eligible for deferral.

* Indicates Required

I would like to defer payments on the following loan(s):

• Account Number *
• Loan Number *
• Loan Number
• Loan Number
• Visa Number(Last 4)

• Please indicate number of payments to skip (Maximum 3 Months) *
• Date Regular Payments Resume *

• Terms Agreement
  By typing my name and clicking this button, I/we attest that the Covid-19 Pandemic has caused an adverse effect on my/our household income, resulting in my/our inability to make our regularly scheduled payments at this time. *
• Contact Phone Number *
• Contact Phone Number (Co-Borrower)
• Electronic Signature Agreement
  I agree to use an electronic signature on this electronic document. (Read More) *
• Electronic Signature Agreement (Co-Borrower)
  (Co-Borrower) I agree to use an electronic signature on this electronic document. (Read More)
• Name (Signature) *
• Co-Borrower Name (Signature)

*I understand that the terms and condition of my loan agreement still apply, except that there will not be any regular monthly payments required on the approved requested deferral period. Afterwards I must make my regular monthly payments. I under- stand that finance charges will continue to accrue during the deferral period. I understand that deferral of my regular payments will result in having to pay higher total finance charges, and that my loan repayment schedule will be extended. Visa skip-a-pay is available. Visa credit card finance charges will continue to accrue as normal. I also understand that the credit union reserves the right to terminate this offer at any time.