Skip-A-Payment Form

Name:(Please Print)________________________________      Savings Account Number: __________      

Daytime Phone/Cell Number:______________________________________________________

Loan Number:________           Month/Year to Skip:________________

Deduct the $20 processing fee from my: ? Savings ? Checking ? Mail in Check With Form

Signature: ___________________________________           Date:__________

Joint Signature: _______________________________           Date:__________

By signing above, I authorize GPNECU to extend my loan term by one month and deduct a $20 processing free from the account I have indicated above. I understand that interest will continue to accumulate on my loan during the month I skip my payment.

I further understand that payments made by payroll deduction or direct deposit will be deducted as normal, however the funds will be deposited into my savings account #____________ instead of posted to my loan #___________. I will be able to withdraw those deposited funds anytime after the scheduled date of deposit.

Initial _________ Joint Initial ________


FOR CREDIT UNION USE ONLY
Credit Union Approval _______ or Denial _______           Loan Officer _________________________
Payroll or Direct Deposit _________           Date $ Moved to Savings _________________
Reason for Denial__________________________________________

GA Power NE Credit Union
285 Newton Bridge Road
Athens, GA 30607
Phone: 706-559-0051
Fax: 706-559-9602

You Must Print, Sign, and Return to Credit Union
(by mail, fax or in person)
A signature is needed to complete the process