Finance & Legal
Financial Hardship Application
Let customers or members apply for temporary financial relief — hardship type, income and obligations, requested assistance, and supporting documentation.
- Questions
- 18
- Style
- One question at a time
- Price
- Free
Financial Hardship Application
Let customers or members apply for temporary financial relief — hardship type, income and obligations, requested assistance, and supporting documentation.
About you
Your name*
Email address*
We send decisions and next steps here.
Phone number*
Account or membership number*
Primary reason for hardship*
When did the hardship begin?*
Describe your situation*
Describe the hardship type
Currency for amounts below*
Current monthly household income*
All sources combined — salary, benefits, support payments.
Monthly fixed obligations*
Rent, utilities, loan minimums, insurance — recurring essentials.
Amount currently owed to us*
What assistance are you requesting?*
Monthly amount you could pay (if requesting a plan)
How long do you need relief?*
Supporting documents
Termination letter, medical bills, insurance claim — anything that supports your application.
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