Vacation Skip-A-Pay July 2014 Authorization 

*Indicates a required field.

By submitting this form, you authorize Financial Assurance Federal Credit Union to extend your final loan payment by one month. Interest will continue to accumulate on your loan during the month you skip your payment. If your loan payment is made via payroll deduction, the total monthly payment amount will be credited to your Share Savings Account in the month of July. All loan payments must be current to qualify. Please allow a minimum of two weeks for us to process your request.

Vacation Skip-A-Pay July 2014 Authorization * YES, I'd like to skip the July 2014 payment on my eligible loan(s) and understand there is a $35 fee that will be deducted from my Financial Assurance FCU account designated below.
Take the $35 fee from my: * Share Savings Account Share Checking Account
MEMBER INFORMATION ("FROM" ACCOUNT):
Member Account Number	*
Social Security Number	*
Loan Payment Due Date	*
First Name	*
Middle Initial
Last Name	*
Email Address	*
Comments
ELECTRONIC FORM SUBMISSION AGREEMENT: By submitting this form I am verifying the following: 1. The above information entered has indeed been entered by myself, the account owner or joint owner, and that submission of this form gives full authority to conduct the transaction requested above. 2. I understand that I do have the option or right to submit this form in the paper form, which is available upon request by contacting the credit union. 3. Entering my first and last name in the Electronic Signature field stands as the equivalent of a handwritten signature. Therefore, by entering fraudulent or false information, you are commiting forgery and are subject to the equivalent applicable laws and penal action. * Yes, I agree to the terms and conditions of submitting this form Electronically as outlined in the guidelines above.
Electronic Signature (please print your first and last name) *
Date *
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