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:
Terms and Conditions
Do you agree to the Terms and Conditions
Date

MonthDayYear
Date
Signature
Should be Empty:

Skip-a-Pay Application