Signature: _____________________________________________________________________________________________________________I hereby apply to skip my payment for the selected month for accounts above, and authorize Kirtland Federal Credit Union

to add the fee of $25.00 to the balance of the loan. I have read and accept all disclaimers on the back of this form.

Your form must be received in-branch no later than five (5) days before your payment due date. Loan must meet eligibility requirements to qualify*. A $25.00 fee will be applied to the balance of each loan skipped. If your loan is on an automatic payment, you are responsible for suspending your payment.

Indicate the loan payment(s) you wish to skip. For each loan, circle which month to skip (one per loan).

Loan Type (Home Equity/Mortgages Loans/Credit Card ineligible) Suffix Month To Skip

Nov. or Dec.

Nov. or Dec.

Nov. or Dec.

Nov. or Dec.

Nov. or Dec.

EMPLOYEE USE ONLY:

Teller Number: Date:

Member verified eligible: Yes No

First Name Last Name Account Number

Street Address City State Zip Code

november or december2020 APPLICATION

IMPORTANT NOTICES AND DISCLAIMERS

*Return of a form does not guarantee a skip-a-pay was granted; loan will be checked for eligibility.

This entire form must be printed, filled out completely, and returned. Please make a copy for your records before submitting. Loans must be current at the time of Skip-A-Pay processing. Form must be received in branch no later than 5 days before the due date of the requested payment. $25 fee will be added to balance of each loan skipped. Interest will continue to accrue on your loan account(s) and your regular monthly payment due date will resume immediately following the skipped month you indicate on the request form. Skipping payments can affect payment protection and GAP coverage. See your agreement for details. Some restrictions apply. Credit cards, real estate loans, and Home Equity loans are not eligible. Limit one skip per loan account, either November or December but not both. If you make automatic payments through Bill Pay, payroll deduction, or an auto transfer, whether through Kirtland FCU or an outside institution program, you are responsible for suspending your payments for any skipped loans and resuming them after the skip. Log into Online Banking or call 1.800.880.5328 for assistance with altering a Kirtland FCU auto payment. BF10-2020.