SKIP PAYMENT REQUEST
S K I P PAY M E N T R E Q U E S T MEMBER NAME: _________________________________________________ MEMBER NO.: ______________________________ ADDRESS: ___________________________________________________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________________________________________ HOME PHONE: _____________________ WORK PHONE: _____________________ CELL PHONE: _______________________ EMAIL ADDRESS: ____________________________________________________________________________________________
LOAN ID: ________________________
MONTH TO SKIP: ______________________
$25 FEE: _____________________ _____
The $25 skip fee may be paid by cash, check or from your current Listerhill account. Please specify your checking or savings account number here: ____________________________________________________ This Skip Payment Request does not change your current loan payment amount, but it does extend the term of your loan. By skipping a payment, the maturity or final payment date disclosed on the loan, truth in lending disclosure, and/or security agreement will be extended beyond the date originally stated, which means that you will have to make extra payment(s) after your loan would otherwise be paid off. Interest and Payment Protection Premiums will continue to accrue on the balance of the loan from the last payment date and will result in you having to pay higher total FINANCE CHARGES than if you made your payment as originally scheduled. Loans excluded from this offer are all real estate loans, business loans, bad address accounts, lines of credit, Christmas loans, loans in bankruptcy, charged-off loans, loans currently past due more than 10 days, loans that have received extensions (maximum of six skip pays and/or extensions allowed during the term of the loan), workout loans or troubled debt, loans on accounts with a negative checking or savings balance, and single payment loans. If you have GAP protection, any amount of the loan that is skipped may not be covered under the GAP Protection. Members with automatic scheduled payment transfers through Online Banking, through another financial institution, or payroll deduction from your employer must suspend their next scheduled payment.
All co-signers, joint borrowers or guarantors on the loan must also sign this request before the payment can be skipped.
X _________________________________ ______________
X _________________________________ ______________
BORROWER SIGNATURE
SIGNATURE
DATE
DATE
X _________________________________ ______________
X _________________________________ ______________
SIGNATURE
SIGNATURE
listerhill.com
DATE
DATE
Revised 12/2016
LOAN ID: ________________________
MONTH TO SKIP: ______________________
$25 FEE: _____________________ _____
The $25 skip fee may be paid by cash, check or from your current Listerhill account. Please specify your checking or savings account number here: ____________________________________________________ This Skip Payment Request does not change your current loan payment amount, but it does extend the term of your loan. By skipping a payment, the maturity or final payment date disclosed on the loan, truth in lending disclosure, and/or security agreement will be extended beyond the date originally stated, which means that you will have to make extra payment(s) after your loan would otherwise be paid off. Interest and Payment Protection Premiums will continue to accrue on the balance of the loan from the last payment date and will result in you having to pay higher total FINANCE CHARGES than if you made your payment as originally scheduled. Loans excluded from this offer are all real estate loans, business loans, bad address accounts, lines of credit, Christmas loans, loans in bankruptcy, charged-off loans, loans currently past due more than 10 days, loans that have received extensions (maximum of six skip pays and/or extensions allowed during the term of the loan), workout loans or troubled debt, loans on accounts with a negative checking or savings balance, and single payment loans. If you have GAP protection, any amount of the loan that is skipped may not be covered under the GAP Protection. Members with automatic scheduled payment transfers through Online Banking, through another financial institution, or payroll deduction from your employer must suspend their next scheduled payment.
All co-signers, joint borrowers or guarantors on the loan must also sign this request before the payment can be skipped.
X _________________________________ ______________
X _________________________________ ______________
BORROWER SIGNATURE
SIGNATURE
DATE
DATE
X _________________________________ ______________
X _________________________________ ______________
SIGNATURE
SIGNATURE
listerhill.com
DATE
DATE
Revised 12/2016
