Member Authentication Form

Please enter your member information below

Date of Birth *

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Social Security Number (last 4 digits) *

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Member Email *

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Loan Deferral Request

You may submit one deferral request at a time. Note: You will be required to choose one reason for your deferral below. Please only select OTHER if you don’t see your reason listed, as this may require a manual review. If we can’t approve your deferral online, we’ll review your request and reach out to you within 3 business days. Please proceed with your submission.

1. Select the loan you want to defer payment on. *

Select the loan you want to defer payment on.

1a. Enter your loan number (this is your member number and account suffix) for a loan if it’s not listed above. *

Enter your loan number (this is your member number and account suffix) for a loan if it’s not listed above.

2. Please tell us why you are requesting to defer your loan payment (choose one): *

Please tell us why you are requesting to defer your loan payment (choose one).

2a. Please share the details of your financial hardship.

Please share the details of your financial hardship.

3. Acknowledge Deferral Addendum.*

PATELCO CREDIT UNION

CREDIT CHANGE IN TERMS ACKNOWLEDGEMENT

Date:

Member Name:

Member number:

Current Outstanding Balance:

Current Due Date:

I am unable to make the payment(s) on the loan listed above at this time and request the following payment(s) be deferred:

The interest component of the deferred payment(s) will be deferred and collected at the time loan payments resume. If at any time a payoff statement or demand is requested, the deferred interest amount will be included in the statement and will be collected at the time of payoff.

Following the loan deferral, your regular scheduled payment is due on:

If this accommodation is granted on a credit card or line of credit, a condition of this accommodation is freezing your line for the period covered by this deferral and for 90 days after. If you make all contractual payments due for 90 days after the deferral period ends by the end of the grace period, the freeze will be removed, and you will be able to use your available line up to the approved limit. If the loan is not kept current your line will be permanently closed.

In this example the payment is due on the 1st of every month and the grace period is 10 days:

Paid as agreed freeze will be lifted after 3rd payment
Payment due date at time deferral processed:	Payment due date	Date paid
1st payment deferred	January 1, 2024	Deferred
2nd payment deferred	February 1, 2024	Deferred
1st payment due after deferral period	March 1, 2024	March 3, 2024
2nd payment due after deferral period	April 1, 2024	April 2, 2024
3rd payment due after deferral period	May 1, 2024	May 4, 2024

Not Paid as agreed Line will be permanently closed
Payment due date at time deferral processed:	Payment due date	Date paid
1st payment deferred	January 1, 2024	Deferred
2nd payment deferred	February 1, 2024	Deferred
1st payment due after deferral period	March 1, 2024	March 3, 2024
2nd payment due after deferral period	April 1, 2024	April 2, 2024
3rd payment due after deferral period	May 1, 2024	May 14, 2024

IF YOU ARE ENROLLED IN THE ‘LEVEL UP’ PROGRAM, THIS BENEFIT WILL BE RESET

If this is an auto loan with GAP protection, the loan deferral may impact payment of future claims.
Except as stated in this deferral the terms of the original Note or Credit Agreement remain in full force and effective.
Deferred payments can affect your ability to refinance. If an internal refinance is being considered, three consecutive monthly payments must be made after the deferral period to ensure eligibility.

I have read, understood, and agree to the foregoing terms and conditions.

Member acknowledged.