Domino Skip-A-Pay Request Form 2021

Skip your qualifying November, December or January loan payment and use the extra cash for any need!*
Am I eligible to skip a loan payment?

You may be eligible to skip your monthly loan payment, provided that all of your Domino Federal Credit Union accounts are in good standing, current and your form is completed in its entirety and turned in at least 10 days prior to the loan due date.
What loan payments can I skip?

Most Domino loans are eligible. Loans that are NOT eligible and do not qualify for the Skip-A-Payment program include Real Estate Loans, Visa and Visa Gold Credit Card Accounts, loans with less than a three month payment history, and / or delinquent loans and accounts not in good standing.
Skip A Payment Request
Member Name*

First NameLast Name
Member Number:*
Phone Number*

Area CodePhone Number
Email Address (for confirmation of skip-a-pay)*
example@example.com
Deduct my $25 processing fee per loan from my (choose one):*

Savings AccountChecking AccountOther
Loan number to skip*
Payment to skip (select one):*

Skip my November 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my December 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my January 2025 Loan Payment. Request must be received 10 days prior to payment due date.

Skip Additional Loan Payments
Loan number to skip
Payment to skip (select one):

Skip my November 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my December 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my January 2025 Loan Payment. Request must be received 10 days prior to payment due date.

Skip Additional Loan Payments
Loan number to skip
Payment to skip (select one):

Skip my November 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my December 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my January 2025 Loan Payment. Request must be received 10 days prior to payment due date.

Skip Additional Loan Payments
Loan number to skip
Payment to skip (select one):

Skip my November 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my December 2024 Loan Payment. Request must be received 10 days prior to payment due date.Skip my January 2025 Loan Payment. Request must be received 10 days prior to payment due date.

Primary Member's Signature*

Clear
*A $25.00 processing fee will be required for each loan before the Skip A Payment is processed. Only 1 Skip A Payment is allowed every 6 months on each qualifying loan. Your interest will continue to accrue and the skipped payment will cause your loan to extend beyond the original maturity, which may change the total amount and schedule of repayment. All other terms and conditions of the loan will remain unchanged. If your loan is insured with Credit Life and/or Disability, your monthly premium for coverage will still be added to the loan on the skipped month. Refer to contract for loans with GAP coverage.
Federally insured by NCUA
Should be Empty:

Skip A Payment Request