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**
SOUTHEAST BANK REQUEST
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:
Name of School:
OPEID
SECTION 2: AUTHORIZED OFFICIAL'S CERTIFICATION
I meet the qualifications as stated in the cover letter for the deferment type 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
FOR SCHOOL DEFERMENT
Date
Employer Name:
Employer Telephone Number:
Signature of Authorized Official
Expected Graduation Date:
STATUS
Full Time
Half Time
I understand that the servicer may apply an in school forbearance during my enrollment if my loan(s) are no longer eligible for deferment.
I understand that my loan(s) may be eligible to have additional deferment added immediately after I cease to be continuously enrolled at least half time.
Records Code: APFG/FBSEB
Revision Date: 06/2019
Student's Name
