Please Complete the Following Information to Take Advantage of the Skip-A-Payment

QUALIFICATIONS  Account(s) must be in good standing  No previous extensions or modifications within the last 6 months  All borrowers must sign the Agreement  Consumer, Personal or other Consumer Secured Loans  Pick the month in 2017 you wish to Skip

AGREEMENT  Interest will continue to accrue on the outstanding balance of your loan until paid in full  The original maturity date will be extended 1 month and you will continue to make monthly payments after the original maturity date until all principal and interest is fully paid.  The existing pledge of security shall remain in effect until the loan is fully repaid  The next regular payment will be due on the regularly scheduled payment due date following the month elected to skip.  Any credit life and or credit disability insurance on said loan will not extend beyond the original maturity date of the loan.

Please complete the following information to take advantage of the Skip-A-Payment

Borrower:______Co Borrower: ______(Print your name here, please) (Print your name here, please) Loan # ______Loan # ______

Email this signed and dated form to [email protected], give to any banker, or mail to: Iowa State Bank, PO Box 1010, Fairfield, IA 52556 Month to Skip-A-Payment: ______

I/we have read and agree to the terms/conditions disclosed:

Borrower’s Signature: ______Date: ______Co-Borrower Signature: ______Date: ______

Loan Officer Approval by: ______

Member FDIC and Equal Housing Lender