Borrower Signature
I consent to the lender and any other owner, holder, servicer, guarantor, or insurer of my account to contact me about my account via auto dialer or
similar device and/or using a prerecorded or artificial voice or message for any lawful purpose utilizing any cellular telephone number(s) I provide,
even if I am charged for the call under my phone plan. Providing my mobile or alternative telephone number(s) and electronic mail address(es) to
the lender is voluntary and I am under no obligation to do so. If I do not elect to provide a mobile or alternative telephone number, or electronic
mail address, it will not affect the consideration or disposition of my deferment request.
Please read entire application before completing. All items relevant to your request must be completed.
**INCOMPLETE ITEMS MAY BE CAUSE FOR DENIAL**
PRIVATE EDUCATION LOAN
Email Address:
Telephone Number:
Alternate Telephone Number:
City:
Zip Code:
Address:
Borrower Name:
Borrower Account Number:
SECTION 1: BORROWER INFORMATION
Zip Code:
Name/Title of Official
Address:
Telephone Number:
Institution/Organization Name:
DOE Code:
SECTION 2: AUTHORIZED OFFICIAL'S CERTIFICATION
I meet the qualifications as stated in the cover letter for the deferment type check above and request my lender/servicer to defer repayment of my
eligible education loans(s). If my loan program allows, accrued and unpaid interest may be capitalized, added to the principal balance, in accordance
with the terms of my credit agreement. I understand that in accordance with the terms of my original credit agreement, I may be required to pay
accrued interest during periods of deferment. I understand that, should my situation under which I applied for deferment change, I must notify my
lender/servicer immediately.
SECTION 3: DEFERMENT AGREEMENT
State:
State:
I certify that the borrower is eligible for the deferment and meets all of the requirements on the cover sheet.
Program Begin Date:
Program End Date:
City:
My signature indicates that I am an Authorized Official and the certification above is true to the best of my knowledge.
Return completed form to: American Education Services * P.O. Box 2461 * Harrisburg, PA 17105-2461
Date
REQUEST FOR DEFERMENT
Date
Employer Name:
Employer Telephone Number:
Signature of Authorized Official
Expected Graduation Date:
SCHOOL
Full Time
Half Time
