P.O. Box 1365, 140 Lucy Lane
Waynesboro, Virginia 22980 (540)946-
3200 Toll Free: 1-800-245-8085
Consumer Loan Payment Deferral
DCCU Use Only
I hereby request DuPont Community Credit Union to defer my next loan payment(s) by signing below.
*Please note this form cannot be used for Mortgages, Student Loans, and Credit Cards. I understand that if a request is made on a line of credit, my/our limit will be
removed.
I hereby authorize DuPont Community Credit Union to defer my next loan payment(s) by signing below for the following reason.
Account Number: Loan Suffix: Defer Payment(s) for Month(s)
FEE: If my Loan Payment(s) Deferral is approved, please transfer the $30 fee for each payment deferred from my account.
Checking Savings
Two (2) Loan Payment Deferral fees per loan may be refunded during the life of the loan.
I understand that the terms and conditions of my loan agreement will apply except that there will not be any regular monthly
payments required during the deferral period set forth above.
• Interest will continue to accumulate on your loan during the month(s) you deferred your payment, deferral of my
regular or minimum monthly payments will result in my having to pay a higher total FINANCE CHARGE and my loan
repayment schedule will be extended.(Under some circumstances your payment may not cover the finance
charges (interest) that accrue and "negative" amortization could occur.)
• Thereafter, I must make my regular monthly payments.
All loan deferrals may be subject to credit union approval. DuPont Community Credit Union may not defer my loan payment if I
do not have a sufficient available balance in the deposit account listed to pay the administrative fee, or if my check for the
administrative fee is returned. If there is a co-signer and/or co-borrower you agree to have them sign this form also to be valid.
The offer does not apply to (student loans or credit card accounts). Please note: If you have GAP Insurance Coverage on your
auto loan, the maximum number of deferred payments during the life of your auto loan is referenced in you GAP Insurance
Coverage Agreement. If more than the allowed are deferred, we will not pay the portion of the deficiency that would equal the
additional deferred payments. DCCU reserves the right to obtain a credit report to make a credit decision.
Borrower Signature Date
Co-Applicant or Co-Signer Signature Date
Co-Applicant or Co-Signer Signature Date
For Office Use Only:
The Loan Payment Deferral is: Approved Denied
DCCU Employee Signature Date
Name Title
Notes:
Run "Loan Skip/Interest Payment/DDC" Specfile
Review Any Automatic Payments/Distributions and Modify Start Date if needed
Review Any DBOs and Complete Form to Modify Start Date if needed
Member Name:
Loan Number:
Total SAP
incl. this request
Originating Branch:
Current Due Date, Before Skip:
Closing Branch:
MSE:
Amount:
