MEMBER ACCOUNT NUMBER: _____________________________
MEMBER NAME(S): _______________________________________
PHONE NUMBER: ________________________ E-MAIL: _________________________
Please check one:
q I’d like to skip the _______________payment on my installment loan.
q I’d like to skip the _______________payment on my Home Equity loan.
q
I’d like to skip the
_______________payment on my VISA
PAYMENT OPTIONS Check one & complete. Processing fee is $20 per loan skipped.
q Enclosed is a $20 check made payable to “Hartford Healthcare Federal Credit Union”.
q Please deduct $20 from my account (circle one): Share or Share Draft
I WOULD LIKE TO SKIP MY (circle one): AUTO Loan Number__________________
PERSONAL Loan Number_____________
HOME EQUITY Loan Number____________
VISA __________________________________
I (WE) WISH TO PARTICIPATE IN THE LOAN SKIP-A-MONTH EXTENSION PROGRAM OFFERED BY THE HARTFORD HEALTHCARE FEDERAL CREDIT UNION AND REQUESTED BY THE BORROWER (S). I (WE) UNDERSTAND THAT BY PARTICIPATING IN THE PROGRAM, THE ORIGINAL TERM OF THE NOTE WILL BE EXTENDED. I (WE) ALSO UNDERSTAND THAT THE INTEREST WILL CONTINUE TO ACCRUE DURING THE EXTENSION PERIOD AND THAT A GREATER PORTION OF MY NEXT PAYMENT WILL BE APPLIED TO INTEREST.
I (WE) REMAIN OBLIGATED FOR PAYMENT OF BOTH PRINCIPAL AND INTEREST AT THE SAME RATE OF INTEREST AS PROVIDED IN THE ORIGINAL NOTE. I (WE) AM BOUND BY ALL PROVISIONS OF THE ORIGINAL NOTE AND UNDERSTAND THAT THE ORIGINAL NOTE REMAINS IN FULL FORCE AND EFFECT EXCEPT FOR THOSE CHANGES MADE IN THIS AGREEMENT. I (WE) REALIZE THAT IF I (WE) TAKE A LONGER TIME TO PAY OFF WHAT IS OWED THAN STATED IN THE ORIGINAL NOTE, THAT THE FINANCE CHARGE AND TOTAL PAYMENTS WILL BE HIGHER THAN THE ORIGINAL AMOUNT STATED.
BORROWER’S SIGNATURE: ______________________________________ DATE_____________
CO-BORROWER’S SIGNATURE: ___________________________________ DATE_____________
FOR CREDIT UNION USE ONLY:
APPROVED BY:_________________________ DATE:______________