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