Disclosure: By completing this form, The Grant County Bank “GCB” will defer payment of your term loan listed above for a period of up to three months. The current balance of the loan is extended by the amount of the deferred payments. Interest will continue to accrue during the time for which the payment is being deferred. You are requesting GCB to advance the due date on each eligible loan which you have indicated above. Your next regular payment will be due on the regularly scheduled due date that occurs after the expiration of the three month deferment period. This deferment will cause the maturity date of your loan to be extended by three or more months, depending upon the amount of interest deferred, time to maturity and the dates and amounts of future payments. If there is more than one borrower on the loan, you acknowledge that you have informed all borrowers and guarantors of the deferred payment(s).

If your mortgage loan has escrows set up for real estate taxes, hazard or flood insurance, you acknowledge that this deferment may cause an escrow shortage and/or deficiency upon your next annual escrow analysis and may result in a higher monthly payment over the twelve months following the analysis. For loans with only interest due upon payment, you acknowledge that this deferment may cause an increase in your first payment after the deferment period.

ANY SINGLE PREMIUM CREDIT LIFE, ACCIDENT AND HEALTH, OR GAP INSURANCE POLICY IS NOT EXTENDED BEYOND THE ORIGINAL MATURITY DATE STATED ON THE ORIGINAL POLICY.

All other terms and conditions of the note and other documents that are part of the entire agreement related to the loan listed above remain the same. If you have any defaults in the interim, this deferral may be terminated by GCB, at its sole discretion, without prior notice. The final payment may be larger than your regular monthly payment.

You authorize us to contact you regarding your request or your loan(s) at any cellular or landline telephone number that you provide now or in the future. You agree to make yourself available upon request to sign this agreement in person, if so requested, no later than 180 days from the date of your electronic signature.

This agreement is governed under the laws of the same state which laws govern the terms of the note and/or mortgage evidencing the loan.

Acknowledgment: I acknowledge that by submitting this form, I agree to the terms of the agreement stated above and my submission constitutes my electronic signature.