Name Date
Home # Cell # Email
Account # Loan #
Payment month and year to be skipped (1 skip per form): /
(You may defer your regularly scheduled loan payment twice per calendar year.)
My Current Loan Balance is Skip-Processing Fee
$0.00 - $2,999.99 Does not qualify
$3,000.00 – $4,999.99 $15
$5,000.00 – $7,499.99 $25
$7,500.00 – $9,999.99 $40
$10,000.00 – $14,999.99 $55
$15,000.00 – $19,999.99 $75
$20,000.00 and greater $100
Take my skip-processing fee from my account #
(Skip-processing fee is due at the time of application.)
I hereby request to defer principal and interest payments on my loan identified above.
If I have authorized Reliant Community Federal Credit Union to debit monthly payments from an external account (“ACH Debit”)
to this Reliant loan, I request this ACH Debit to be temporarily stopped for the month I am requesting the Skip-A-Payment and
resumed for the next regular payment. If I have set up scheduled recurring transfers or ACH Debits through online banking,
I understand that I am responsible for suspending those payments for the month I am requesting the Skip-A-Payment.
I acknowledge that I have read and fully understand all the provisions for the Skip-A-Payment Plan.
Borrower’s Signature
Co-borrower’s Signature
Skip-A-Payment Plan Application Form
Savings
Checking
Other
Reliant’s Skip-A-Payment Plan allows you to defer your regular loan payment twice per calendar year. Your next
regular payment will be due as scheduled. To take advantage, review the plan below to see if your loan qualifies.
If it does, simply complete the short request form and return it to any Reliant branch.
If you defer a payment, the total FINANCE CHARGE that you pay on your loan will be greater than what was
stated on your loan contract. This and any other previous or future deferments will extend the term of your
loan. If you elect to have the credit disability or life insurance coverage on the loan and then elect to defer
payments using the Skip-A-Payment Plan, your coverage will not cover the entire term of the loan.
Qualifying Loans:
• Balance of $3,000 or more
• Annual Percentage Rate of 11.00% or lower
• Term of 120 months or less
• 6 or more loan payments have been made
• Skipped no more than two consecutive
payments
Skip-Processing Fee:
The fee will be charged based on your loan balance as outlined below. You may choose to have your
skip-processing fee deducted from a Reliant account, or enclose the fee when you return your request form.
10-23
Loans Not Eligible for Skip-A-Payment Plan:
• Any loan that does not meet the qualification criteria at left
• Members who have any loan with Reliant that is more
than 45 days past due
• The following loan types are ineligible, regardless of
whether they meet the qualification criteria at left:
-First mortgage loans, home equity loans/lines, loans
secured by collateral mortgages on real estate
-Visa credit cards and overdraft lines of credit
-Certificate secured loans
-Business loans
-Student loans
**Submit (Submit only) completed form to Core and create appropriate Opportunity**
Please note: If you defer a payment, the total finance
charge that you pay on your loan will be greater than
what was stated on your loan contract. This and
any other previous or future deferments will extend
the term of your loan. If you elect to have GAP and/
or Credit Disability or Life Insurance coverage on
the loan and then elect to defer payments using the
Skip-A-Payment Plan, your coverage will not cover
the entire term of the loan.