Name: Account #
You are requesting a one-month payment deferment on your loan. This will extend the original maturity date of the loan by the length of the payment deferment. Interest accrual will continue on a daily basis and will include the deferment period. Any adjustment to the payment schedule of the original loan contract may cause the loan to amortize differently than originally contracted.
Minimum requirements for a payment deferment:
• A minimum of 12 payments made between deferment requests.
• A maximum of three deferments are allowed for the life of the loan.
• No more than a one-month deferment can be requested in a 12 payment period of time.
• A minimum of 12 payments must have been made.
I request a change to the payment schedule of this loan and wish to extend this loan's maturity date by the number of payment deferments requested. I understand that this request is limited to loans that have been paid regularly and on time. Personal financial situations have arisen that make such a request necessary.
I acknowledge that during the deferment period CULS will continue to accrue finance charges on a daily basis for the length of the deferment period.
Reason for Request:
Phone #: () - Email:
I hereby authorize The Credit Union Loan Source to accept the checking of this box in lieu of my signature.
ACH ON FILE YES
NO (IF YES PLEASE READ THE STATEMENT BELOW)
***ACH ON FILE*** If you have an automatic ACH authorization scheduled to be drafted from your checking or savings account, it is YOUR responsibility to cancel this transaction if you do not want the funds withdrawn. Please indicate if you have an ACH transaction scheduled and submit an ACH cancellation form along with your extension request form.
**Please note** All outstanding fees such as late fees, non-sufficient funds fees, etc. must be brought completely current prior to the implementation of any Due Date Change, Deferment or Loan Modification. Failure to pay these fees will result in a delay and/or denial of your request.**
Type the correct combination of letters and numbers as shown above:
Note: Please click on the Submit button only one time.
The COMPANY will respond to your transmission within one business day.