Sample Repayment Agreement

You can use the sample repayment agreement form below if you received a letter from a creditor demanding payment, or simply to renegotiate your debt and obtain lower, revised terms that you can manage.

If the creditor has agreed to your terms:

  • Make the payments agreed upon as soon as you can and in full.
  • Request written confirmation of the creditor’s agreement.
  • Save all documentation and correspondence.
  • Request and keep all payment receipts.
  • Communicate with the creditor only on paper and by certified mail.
  • Keep all your promises and make sure the other party follow through on all agreements.

If the creditor has agreed to remove any negative information from your credit report, verify that the clearance actually does show up within the next three months.

If you feel you have been contacted by mistake and that you don't own the debt the creditor is attempting to collect, write a letter requesting the following:

  • An detailed explanation as to what the money owed is for.
  • Copies of any signed contracts they have made with you in regards to the debt.
  • The name and contact information of the original creditor.
  • A complete history of your payments since the beginning (established by the case Fields v. Wilber Law Firm, Donald L. Wilber and Kenneth Wilber, USCA-02-C-0072, 7th Circuit Court, Sept 2004.)
  • Proof that the debt falls within the statue of limitations laws of your state.
  • Proof that the current collector or agency legally owns the debt and is legally enabled to collect the debt in question from you.
  • A signed copy of the original credit card application or loan agreement.
  • Copy of the company's license to operate as a collection agency in your state.

Below is a sample repayment agreement letter you can use to start the negotiation.


    (Your address)

    (Creditor's or Debt Collector's Company Name)
    (Mr./Ms. full name)
    (Company's address)

    RE: (Your account number if available)

    Dear (Mr./Ms. collector’s last name):

    After receiving the notice stating that I owe the amount of ($) to your company, I acknowledge that the debt owned is correct.

    Consequently, I intend to bring this matter to a mutually beneficial resolution.

    Unfortunately, my current economic situation would not allow me to make the full monthly payments you request. However, I am able to pay ($) at the (end or beginning) of every month, starting on (put date here).

    Once I receive your letter stating your acceptance of this payment plan and agreeing to provide proof of it to all credit reporting bureaus, noting “Paid as agreed," I will mail you a money order or cashier's check in the amount we have agreed upon.

    Please consider this proposal for it is the best I can do at the moment.


    (Your signature)
    (Your printed name)
    (Your full address)

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Sample Repayment Agreement
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