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Routing #: 211178349
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Skip-a-Pay Request Form

Please complete this form and fill out all the fields below if you wish to skip your Healthcare Financial Credit Union Loan payment (excluding Visa® Credit Cards, Quick-Fix Loans, Real Estate Loans, Personal Lines of Credit and Overdraft Lines of Credit). This is a secure online form; your information will not be shared.

Your request must be submitted by the 23rd of the month for the following month's payment to be skipped, or it will be denied. One of our employees will contact you with a decision. Please ensure that the email address given is your personal email account.

Request Agreement

This form supports encryption technology to protect your personal information while it is in transit.

By completing this form, I understand that Healthcare Financial Credit Union will review my accounts and that there is a $30 processing fee per Loan that I choose to skip. I understand the $30 fee per loan must be available in my Healthcare Financial Credit Union Savings or Checking account (fee will be taken from available funds, Checking will be the first source) at the time the request is processed, and that I cannot be delinquent (past due), or have been delinquent, in the past 12 months on any loans with Healthcare Financial Credit Union for this request to be approved and processed.

I am instructing Healthcare Financial Credit Union to skip my loan payment below:

* - Indicates required field

Transfer the $30 processing service fee per Loan from:

Signature

By participating in Healthcare Financial Credit Union's Skip-A-Payment program, you request that Healthcare Financial Credit Union defer your loan payments as indicated. You agree and understand that: 1) FINANCE CHARGES will continue to accrue during and after the deferral period; 2) deferring payment will result in higher total FINANCE CHARGES than if payment were made as originally scheduled; 3) payment deferral will require extra payments past the original maturity date; 4) elected GAP or Warranty Coverage will not be extended beyond the original maturity date; 5) payments will resume the following month; 6) there is a $30 fee per loan and I understand the $30 fee(s) must be available in my Healthcare Financial Credit Union Savings or Checking account; 7) You must not have had any loan payment more than 30 days late at Healthcare Financial Credit Union within the past 12 months; 8) You must have completed a minimum of three payments on subject loan; 9) Two (2) Skip-A-Payments allowed per twelve month period, six (6) Skip-A-Payments allowed the life of the loan; 10) Skip-A-Payment request must be made by the 23rd of the month to skip the following month payment. If recent data shows that you have been delinquent on the mentioned loan(s) for any reason, Healthcare Financial Credit Union reserves the right to deny your application for Skip-A-Payment. If your request is denied, we will contact you. Loan(s) must be in good standing to accept this offer. Excludes Visa® Credit Cards, Quick Fix Loans, Real Estate Loans, Personal Line of Credit, Overdraft Protection Loans and any loan being paid by credit union disability insurance or other debt protection.

*Electronic Signature Disclosure:

As allowed by the U.S. Electronic Signatures in Global and National Commerce Act (eSign law), Healthcare Financial Credit Union uses electronic signatures on business sales agreements. Please read carefully.

By clicking the checkbox you are agreeing to use an electronic signature, which means:

You agree to use an electronic document and an electronic signature. You understand that electronic signatures are legally binding in the U.S. and other countries.

You agree to read the document and fill it out accurately and completely.

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*APR - Annual Percentage Rate. *APY - Annual Percentage Yield.