HTML Preview Promissory Note Extension Agreement Form page number 1.
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. Specically, the member is obliged to make the above payments
regardless of the a previously identied 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
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Member Name Member Account Number Sufx
Date Daytime Phone Number Alternate Phone Number
Joint Member Name Daytime Phone Number Alternate Phone Number
Loan Extension and Promissory Note