Forms

Deferment Request
DATE:
     
NAME:
ACCOUNT #:
MONTH(S) YOU ARE REQUESTING THE PAYMENT EXTENSION(S) FOR AND .
(A MAXIMUM OF TWO EXTENTIONS WILL BE GRANTED IN A 12 PAYMENT PERIOD OF TIME.)
I ACKNOWLEDGE THAT THIS FORM IS A REQUEST TO CHANGE THE PAYMENT SCHEDULE OF THIS LOAN AND EXTEND THIS LOAN'S MATURITY DATE BY THE NUMBER OF LOAN EXTENSIONS REQUESTED. THIS REQUEST IS LIMITED TO LOANS THAT HAVE BEEN PAID REGULARLY AND ON TIME AND SITUATIONS HAVE ARISEN THAT MAKE SUCH A REQUEST NECESSARY. PROOF OF EMPLOYMENT (MOST RECENT PAYSTUB) AND PROOF OF FULL COVERAGE AUTO INSURANCE (DECLARATION PAGE OF POLICY) ARE REQUIRED.

I ACKNOWLEDGE AND UNDERSTAND THAT DURING THE EXTENSION PERIOD I AM REQUESTING MY LOAN WITH CULS WILL CONTINUE TO ACCRUE FINANCE CHARGES ON A DAILY BASIS FOR THE LENGTH OF THE EXTENSION PERIOD.
REASON FOR REQUEST:
PHONE #: ( ) -
EMAIL:
I hereby authorize COMPANY to accept the checking of this box in lieu of my signature. (Online submission)

ACH ON FILE YES NO (IF YES PLEASE READ THE STATEMENT BELOW)

****Please Be Advised****
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. Please indicate if you have an ACH transaction scheduled and submit an ACH cancellation form along with your deferment request.

*Please also provide proof of your current employment and a declaration page from your current insurance company verifying that you have full coverage insurance (comprehensive/collision) on the vehicle for which you are requesting assistance and confirmation that The Credit Union Loan Source is listed as the primary lien holder on the policy.

**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.**

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