Home » Services Application Leave me blank for Services Application. Please select which service you'd like to apply for. NetTeller Visa Check Card Electronic Statements & Notices Loan Skip-a-Payment First Name/Business Name * Last Name * Address * City * State * Zip * Email * Phone * Date of Birth * SSN/TIN * Mother's Maiden Name * Optional Bill Pay Service: Yes No Last 4 Digits of Account Number NetTeller ID Payment Month You'd Like to Skip * Please Select January February March April May June July August September October November December An applied fee of $25.00 to extend your installment loan for one month will be deducted from your primary account at Farmers & Merchants Bank. By submitting this form, you understand that the maturity date on your loan will be extended one month, and the interest on your loan(s) will continue to accrue during this period. You may elect to skip one loan payment as long as your loan is current. You may skip up to 2 payments per loan in a 12 month period (Jan-Dec). You cannot skip your first loan payment or skip consecutive months. Restrictions May Apply. Submit There was an error, please try again. * Required Thank you for your submission!A member of our team will be in touch with you soon.