Skip-A-Pay Application Form

Skip-a-Pay Application

Thank You for your interest in Skipping your Germania Credit Union payment. Please fill out and submit this form and a Loan Officer will contact you within 2 business days to verify your eligibility and complete your application.
Member Number
Loan Number or Collateral
First Name*
Middle Initial
Last Name*
Date of Birth*

MonthDayYear
Social Security*
Telephone Number (Mobile)*

Area CodePhone Number
Telephone Number (Home)

Area CodePhone Number
Email*
example@example.com
I would like to pay the $30 processing fee:

GCU CheckingGCU Savings
Terms and Conditions
Do you agree to the Terms and Conditions*

YesNo
Date

MonthDayYear
Date
Signature*
Should be Empty:

Skip-a-Pay Application