Holiday Skip a Payment

Please submit a request form for each eligible loan

Customer Information

First Name

Last Name

Origin

Email Address

Mobile Phone Number (10 digits)

Last 6 digits of Social Security Number

Request Skip a Pay on this Loan Account

Loan Number

Payment Month to Skip

$50 Processing Fee

I would like to pay with:

Processing Fee Payment Method:

Payment Method - FFB Bank Account

Enter the FFB Bank Account Number to Draft

Payment Method - ACH Another Bank Account

ACH Authentication Method

Name on Account

Account Type

Bank Routing Number

Account Number

Acknowledgement (online)

I authorize First Fidelity Bank to electronically debit my account $50.

I agree to have sufficient funds in my account for the transaction above, and
understand that my financial institution may assess fees if there are insufficient
funds in my account. I acknowledge that it will not be the responsibility of
First Fidelity Bank to pay any transaction fees that may be assessed by my
financial institution.

In the case of a returned transaction, I authorize the resubmission of the entry
and, as applicable, an additional debit of the above account up to the state
maximum return fee amount.

My entry of the information above and the acceptance of this agreement
shall be my signature to execute this transaction.

The acceptance of this agreement may be revoked prior to the processing
of this transaction, by contacting us at 800-299-7047.

I understand that interest will continue to accrue on my loan, listed above,
and that the final loan payment will be due one month later than originally
scheduled.

I understand that deferment of my payment will extend the life of my loan
and may cause an increase in the final payment amount.

I understand that any credit insurance purchased on the loan will not be
extended past the original maturity date.

I Accept

Acknowledgement (Internal)

I Accept

Skip a Pay Authorization (FFB Account/Cash/Check)

I authorize First Fidelity Bank to electronically debit my account $50.

I understand that interest will continue to accrue on my loan, listed above, and that the final loan payment will be due one month later than originally scheduled.

I understand that deferment of my payment will extend the life of my loan and may cause an increase in the final payment amount.

I understand that any credit insurance purchased on the loan will not be extended past the original maturity date.

I Accept

If you have any questions or issues, please call us at 800-299-7047.