If you answer "Yes" to any of the next three questions, you may not be qualified.

Have you skipped any payments in the past 12 months?	Yes No
Do you have any loans currently outstanding more than 30 days?	Yes No
Have you had any loan 60 days delinquent in the past Six(6) months?	Yes No

 Please Answer the Following Questions

Name:
Last 3 Digits of Your Account#:
How many months would you like to skip:	1 Month 2 Months $20 fee for each Month.
What is the first month you would like to skip:	January February March April May June July August September October November December   5 day notice required
Do you want payments skipped on all of your loans:	Yes No     $20 fee for each payment skipped.

By submitting this request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

When complete - submit application to ISU CU by one of two methods:

• Complete the application, print, sign and date it and mail or fax it in. (FAX Number is: (309) 451-8410)

• Complete the application "on-line" and e-mail it by pressing the Submit button.   See NOTE below.             

NOTE: Any information you submit electronically is not secure and could be observed by a third party while in transit. If you are submitting passwords, credit card numbers, or other information you would like to keep private, it would be safer for you to use method (a)  above. By submitting this application you grant the same rights as delineated under the appropriate signature area above.