SKIP A PAYMENT FORM

Please skip the following payment(s) on my loan(s) at CUP Federal Credit Union

Account #

Loan #

Skip month (Nov, Dec, or Jan)

Account #

Loan #

Skip month (Nov, Dec, or Jan)

I understand that by skipping a payment on my loan, interest will continue to accrue on the unpaid balance and the skipped payment will extend the term of the loan.

Applicant Name (print)

Account #

Phone # (cell)

Phone # (work)

Borrower Signature

Date

Co-Borrower Signature

Date

************************OFFICE USE ONLY************************

Approved Date

Approved By

Comments

This field is for validation purposes and should be left unchanged.