COVID-19 Deferment Application | The Grant County Bank | Petersburg, WV – Keyser, WV

Please provide us with the information below so we can begin processing your request for your payment deferral.

All Borrowers and Guarantors Must Sign

Borrower/Guarantor Name(s)
OK Borrower/Guarantor Name(s) is required
Borrower/Guarantor Name(s)
Optional OK Borrower/Guarantor Name(s) is required
Borrower/Guarantor Name(s)
Optional OK Borrower/Guarantor Name(s) is required
Borrower/Guarantor Name(s)
Optional OK Borrower/Guarantor Name(s) is required
Loan Number
OK Loan Number is required
Current Property Address
OK Current Property Address is required
City
OK City is required
State
OK State is required
Zipcode
OK Zipcode is required

Acknowledgement

- I acknowledge that by submitting this form, I agree to the terms of the agreement stated above and my submission constitutes my electronic signature.
OK I acknowledge that by submitting this form, I agree to the terms of the agreement stated above and my submission constitutes my electronic signature. is required

Please Note

• If you have recurring automatic transfers from other financial institutions for your loan payment(s), it is your responsibility to stop the transfer and restart the transfer when the deferral period ends. Any fees assessed by your other financial institution for doing this are your responsibility.

• Your account must be in good standing to be eligible for this offer.

• You are not obligated to accept the deferral offer in which case you should not submit this form and should continue to make your regular payments.