• Loan Payment Method (check one):

    OKLoan Payment Method (check one): is required
  • Fee From:

    OKFee From: is required
  • OKMember Name is required
  • OKMember Number is required
  • OKLoan Number is required
  • Phone

    OKPhone is required
  • OKE-mail is required
  • I/we understand and agree that my/our loan documents are hereby amended to the effect that there will not be a payment(s) due for such month, that the payments made after this skipped payment will continue to be applied first to interest, with the remainder to principal and that interest will continue to accrue on the loan at the rate per annum specified in the loan documents. I/we also understand and agree that the effect of this skipped payment will be that the final payment on the loan will be due one month after the date it would have been otherwise become due without this skipped payment, and that the amount of the final payment may be higher than the usual payment amount, due to the postponement of the scheduled principle portion of this payment and any other previously skipped payments and additional interest accruing on the skipped principal amount. I/we understand and agree that if I/ we purchased credit life insurance or credit disability insurance as a part of this loan, the deferment of this payment or any previously skipped payments will not extend the insurance coverage beyond the termination date stated in the insurance certificate.

    Please print, sign and return the completed form to a Centric Service Representative. You may also print, sign and email the completed form to mycentric@mycentric.org