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Application for Deferment - Coronavirus - Consumer Loans

Borrower 1 *

Borrower 2

Phone Number

Loan Account Number *

Monthly Income

Source of Income


I am hereby requesting that my monthly payments of principal and interest be deferred until:

Number of months being requested for Deferment:

 **Please note: 5 month deferment maximum**


Explanation of impact from Coronavirus:*


*Cannot be left blank



By checking the box below, I acknowledge, as borrower, that this Deferment shall not constitute a waiver or default of any other right the Bank may have under the loan contract. I further acknowledge that the loan maturity date and any additional accrued interest shall be extended for each month the payment is extended, and that when payments resume at the end of the deferral period, payments will be applied first to interest that has accrued during deferment period.  This may result in more interest than originally factored in my loan documents when this loan was established.

Debt Cancellation coverage and GAP coverage, if applicable, will cease on the original maturity date. Balances remaining after the original maturity date as a result of this Deferment will not be covered.

By checking the box, you are acknowledging that you read and agree with the statement above.