<p>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</p><p>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. </p><p>Please complete the following information to take advantage of the Skip-A-Payment</p><p>Borrower:______Co Borrower: ______(Print your name here, please) (Print your name here, please) Loan # ______Loan # ______</p><p>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: ______</p><p>I/we have read and agree to the terms/conditions disclosed:</p><p>Borrower’s Signature: ______Date: ______Co-Borrower Signature: ______Date: ______</p><p>Loan Officer Approval by: ______</p><p>Member FDIC and Equal Housing Lender</p>