Borrower Name: Co-Borrower Name:
Reason for Modification Request:
You are requesting a Load Modification on your loan. This will extend the original maturity date of the loan by the length of the Modified term. Interest accrual will continue on a daily basis and will include the modification period. Any adjustment to the payment schedule of the original loan contract may cause the loan to amortize differently than originally contracted.
**Borrower Gross Monthly Income: **Co-Borrower Gross Monthly Income:
Mortgage/Rent: Credit Cards:
Auto Insurance: Utilities:
Auto Payment: Other:
**Insurance Company Name: Phone Number:
Comprehensive Deductible: Collision Deductible:
*A minimum of twenty-four payments must be made for modification consideration.
**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 (deductible no more than $1000 each for Comprehensive and Collison), with
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.***
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.