Preview Promissory Note Extension Agreement Form

COLL-001

I desire a Loan Extension of my present terms for the following reasons:

I agree to resume payment on or before . The Credit Union is not relying upon payment

being made from this or any previous source. Specically, the member is obliged to make the above payments

regardless of the a previously identied source. I agree that any late payments or failure to pay the full amount

when due, as set forth above, results in a material breach; will accelerate the entire unpaid indebtedness; and,

allows the Credit Union to immediately repossess any pledged collateral.

Member Signature Date

Joint Member Signature Date

Extension / Promissory Note Recommended by:

Credit Union Representative Date

Extension / Promissory Note Approved by:

Credit Union Representative Date

Credit Union Use Only

WHEREAS the above signed has executed a note in the favor of SANTA CLARA COUNTY FEDERAL CREDIT UNION in the original amount of

$ ______________ with payments of $ ____________________ every _________________ of the month starting _______________________,

_________________, with an unpaid principal of $ _____________________. WHEREAS the above borrower nds that he/she is unable to complete

payment of this loan on the present terms; NOW THEREFORE, the borrower(s) request that relief be given in the form of an Extension/ Promissory

Note. If this extension is approved, I hereby agree to pay the balance remaining due on this note at the rate of ___________% per annum on the

unpaid principal, with minimum monthly payments of $ ________________ every ___________________ of the month. All other provisions of the

original note except those changed by this Agreement remain in effect. I agree I owe the above unpaid sum with out claim against or defense to

the Credit Union. I agree that acceptance of a late payment is not a waiver of future default. I agree to all terms and conditions of the Disclosure

Statements, which I acknowledge have been provided to me upon signing above.

Share Balance: Loan Balance: As of date: Last Paid Date:

Next Due Date:

$ $ Proposed Payment Date:

REV. 07/06

Member Name Member Account Number Sufx

Date Daytime Phone Number Alternate Phone Number

Joint Member Name Daytime Phone Number Alternate Phone Number

Loan Extension and Promissory Note

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