SKIP-A-PAY FORM Focus Federal Credit Union’s Skip-A-Pay program allows qualified members an opportunity to skip eligible loan payment(s) once in a twelve month period. In order to participate in this program, your membership must be in good standing*. You must submit a written Application, Disclosure and Agreement. A $40 application fee will be applied for each payment skip requested and will be withdrawn from your Focus Federal Credit Union (FFCU) account at the time your request is approved. This application is due 7 days prior to your payment due date. *All your loans at FFCU must be current, with no collection action pending. Your account must not be overdrawn and you must have sufficient funds on deposit to cover the $40 application fee. Submitting this application does not guarantee your skip-a-pay application is approved. You will be notified if for any reason FFCU will not be able to honor my Skip-A-Payment request and will hold FFCU harmless for any consequences resulting from rejection of my request.Please complete the following:Date:* Account number:*Name:* First Last Joint borrower's name: First Last Loan suffix number you wish to skip:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:*Email:* Month of payment to skip:*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberIs the payment set up on automatic draft?*YesNoPlease withdraw the $40.00 application fee from:* Savings Checking * I understand that interest will continue to accrue on my loan(s). Real estate loans and MasterCard loan payments cannot be skipped. I understand that any GAP or other insurance may be affected by skipping a loan payment and accept the responsibility of verifying with my insurance company/companies their policies before participating in TFFCU’s Skip-A-Pay program. A separate form must be completed for each loan payment to be skipped. By signing below, I/we request to skip the payment referenced above. I/we agree to pay an application fee of $40 for each request, and I/we agree to all the provisions of the Skip-A-Pay program as described in this disclosure.Borrower's signature:*Date:* Joint borrower's signature:Date: You can fax the application to Focus Federal Credit Union at 405-488-2818. You may also submit your application in person at any of our branches or by mail to Focus Federal Credit Union, 420 NE 10th Street, Oklahoma City, OK 73104. Attn: Skip-A-Pay.NameThis field is for validation purposes and should be left unchanged.