Name* First Last TotalAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code HiddenAddress Email* Phone*Account Number* Loan Suffix Being Skipped* Agreement* I understand that skipping my next eligible payment will extend my loan(s) past maturity. Doing so will not affect my payment record since the skipped payment will be added to the end of my loan. Interest will continue to be calculated on the outstanding balance. Payment for the $35.00 skip fee per loan is indicated below. Please note: Skipped payments, including approved skipped payments, are NOT covered by GAP. In the event of a GAP claim, any skipped payments will be deducted from the outstanding balance paid off by GAP. Skip-a-Pay cannot be applied to Credit Card, Home Equity, Mortgage Loan, Line of Credit, or Student Loan payments. Digital Signature of Primary Borrower* First Last Digital Signature of Joint Borrower First Last Agreement Date* MM slash DD slash YYYY Pay with* Credit or Debit Card Transfer from Community West Savings Transfer from Community West Checking Credit or Debit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Skip-a-Pay is currently unavailable. Please check back in November for Winter Skip-a-Pay. Thank you!
