Skip A Payment Authorization Take This Month Off I would like to participate in the Skip a Payment promotion and authorize Highpoint Community Bank to debit the $65.00 extension fee from my Highpoint Community Bank deposit account in lieu of my monthly payment. Further, I realize that the final maturity date of my contract will be extended because of my acceptance, resulting in additional interest. Name:* First Last Loan Number:*Eligible only on Personal Loans.Highpoint Community Bank Account Number:*$65 extension fee will be debited from this account.Advantage Checking free Skip A PaymentIf you have a HCB Advantage Checking account you are allowed 1 free Skip A Payment per calendar year. If you would like to use this option, please check the box below. Use free Skip A Payment Which payment would you like to skip?*Submission of this form authorizes a debit to the Highpoint Community Bank account listed above in the amount of $65.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.