Forms

Loan Modification Request
ACCOUNT#
 
   
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 INFORMATION
CO-BORROWER INFORMATION
HOME PHONE:
 
HOME PHONE:  
PROPERTY ADDRESS:
 
PROPERTY ADDRESS:  
CELL PHONE:
 
CELL PHONE:  
EMPLOYER:
 
EMPLOYER:  
WORK PHONE:
 
WORK PHONE:  
POSITION:
 
POSITION:  
CONTACT:
 
CONTACT:  
EMAIL ADDRESS:
 
EMAIL ADDRESS:  
Financial Information
**BORROWER GROSS MONTHLY INCOME:
  **CO-BORROWER GROSS MONTHLY INCOME:
MONTHLY EXPENSES:
     
MORTGAGE/RENT:
  CREDIT CARDS:
AUTO INSURANCE:
  UTILITIES:  
AUTO PAYMENT:
OTHER:
     
INSURANCE INFORMATION:
     
**INSURANCE COMPANY NAME:
  PHONE NUMBER:  
POLICY NUMBER:
     
EFFECTIVE DATES:
     
FROM:
  TO:  
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.***

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