Loan Payment Assistance Request

Solarity recognizes financial hardships can happen to anyone. Financial hardships may create difficulty in adhering to your original loan terms. Solarity is here help. We want to work with you throughout your unique financial situation. Please complete one request per loan you are seeking payment assistance with. **If completing on mobile device, best formatted on landscape display**

Your Full Name*

Please provide name as listed as primary borrower on loan

Your Mailing Address*

City, State Zip*

Your Phone Number*

Please include area code

Your Email address*

Full Name of Co-Borrower

Please provide name as listed as co-borrower on loan

Co-Borrower Phone Number

Please include area code

Co-Borrower Email address

Preferred Method of Contact*

Your Member Number

Please provide your member number if known

Loan Type*

Select

Physical Location*

Please provide the physical location of the collateral used to secure the loan. (Location of car/RV/boat/house) If loan is unsecured, please indicate "unsecured" as your response.

Insurance*

Yes /Si - Full Coverage / Seguro de cobertura completa

No - Solarity added force placed insurance on my loan / Solarity agrego seguro de fuerza a mi prestamo

N/A

Assistance Type*

Temporary / Temporal - Less than 2 months / menos de 2 meses

Temporary / Temporal- Less than 6 months / menos de 6 meses

Permanent assistance / Asistencia permanente

Other / Otro

Hardship Reason(s)*

Please select the reason for financial hardship at this time.

Select

Additional Hardship Information*

Please provide any additional information that may be necessary for Solarity to know when reviewing your request for payment assistance of your loan. NOTICE: Please leave out any detailed medical details for your privacy.

Assistance Request Details*

Please describe the type of assistance you are requesting. Please be specific as possible in the payment amounts and terms. We will review information and be in touch with you via phone to discuss a potential solution.

Borrower(s) Certification and Agreement*

Borrower Certification and Agreement 1. I certify and acknowledge that all the information in this Payment assistance request is truthful. Knowingly submitting false information may violate Federal and other applicable law. 2. I acknowledge and agree that Solarity is not obligated to offer me assistance based solely on the representations in this document or other documentation submitted in connection with my request. 3. I consent to Solarity obtaining a current credit report for the borrower and co-borrower. 4. I agree that the terms of this borrower certification and agreement will apply to any modification trial period plan, or repayment plan that I may be offered based on this application. If I receive an offer for a modification trial period plan or repayment plan, I agree that my first timely payment under the plan will serve as acceptance of the plan. 5. I consent to being contacted at any telephone number, including mobile telephone number and via text or email address I have provided to Solarity Credit Union. 6. All regulatory compliance information may not be included on this request form. I understand I am only submitting a help request form. All applicable regulatory compliance information will be included in any formal banking document that I am asked to sign digitally.

Digital Signature Authorization*

By providing your name below you authorize Solarity to review your request for payment assistance. **If a modification is offered, all borrowers on loan will be required to sign to accept new terms**

File Attachments

If necessary, please include any additional information you would like Solarity to use in consideration of your modification request.

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