To: Greenfield Savings Bank
RE: COVID-19 Residential Loan Relief Program

I would like to opt-in to the Greenfield Savings Bank COVID-19 Residential Loan Relief Program.

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* 1. I have experienced (check all that apply):

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* 2. I would like a payment deferment of:

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* 3. For my (check all that apply):

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* 4. Daytime Phone Number

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* 5. Email Address

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* 6. Date

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* 7. Name (First and Last)

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