Payment Due Date Change Request Form

Payment Due Date Change Request Form

Please complete the following information:

Today's Date

Desired New Payment Date

Customer Name

Street

City

State

Zip

Account Number

Please note that in order to process your request, the following criteria must be met: ? You have made the first payment on your loan. ? Your requested due date is not more than 15 days from your existing due date. ? This is your first request for a due date change. (Only one change is allowed during the term of the loan.) ? Your account is current or no more than 10 days past due.

Signature of Account Holder:

Customer Signature

By signing above you are authorizing us to change the payment due date on your account. If your payments are paid through the Automatic Loan Payment (ALP) Program, you agree to the new transfer date outlined in the Terms and Conditions of the Automatic Loan Payment Authorization based on your new payment due date. You understand that no other terms agreed upon in your Contract or Automatic Loan Payment Authorization have been changed,

Once you have signed the request form, use one of the following options to submit your request:

Mail: Wells Fargo Dealer Services MAC E2717-023 PO Box 19733 Irvine, CA 92623-9733

Fax: 1-888-937-1655

Online: For your added convenience, you can now request a due date change electronically through your eServices account at .

If for some reason your request is not approved, we will notify you by mail. If you have questions, please call us at 1-800-289-8004, Monday - Friday, 5:00 a.m. to 7:00 p.m. Pacific Time. We accept telecommunications relay service calls.

OF-52 (12/12/14) Wells Fargo Dealer Services is a division of Wells Fargo Bank, N.A. ? 2011 Wells Fargo Bank, N.A. All rights reserved.

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