Debt Settlement Agreement - Sample 2
Sample formal debt settlement agreement form
SETTLEMENT AGREEMENT AND RELEASE
Agreement Date: [DATE]
PARTIES:
CREDITOR: [Creditor/Collection Agency Name]
Address: [Address]
City, State ZIP: [City, State ZIP]
DEBTOR: [Your Full Name]
Address: [Your Address]
City, State ZIP: [City, State ZIP]
SSN: [Last 4 digits]
BACKGROUND:
WHEREAS, there exists an outstanding debt account number [ACCOUNT NUMBER] originally owed to [Original Creditor] in the amount of $[ORIGINAL AMOUNT]; and
WHEREAS, this debt has been assigned to/is being collected by [Current Collector], and the current outstanding balance is $[CURRENT BALANCE]; and
WHEREAS, the parties desire to settle this matter without further dispute or litigation;
NOW, THEREFORE, in consideration of the mutual covenants herein, the parties agree:
1. SETTLEMENT
Creditor agrees to accept $[SETTLEMENT AMOUNT] as payment in full settlement of the above-referenced account, which currently has an outstanding balance of $[BALANCE].
2. PAYMENT
Debtor agrees to pay the settlement amount of $[AMOUNT] via [payment method] by [DATE]. Payment details: [payment instructions]
3. FINAL SETTLEMENT
Upon receipt of the settlement payment, this account shall be forever settled and satisfied. Creditor shall take no further collection action.
4. CREDIT BUREAU REPORTING
Creditor agrees to report this account as "Settled in Full" to all credit reporting agencies. Creditor further agrees to request deletion of all negative account history from credit bureaus within 30 days of receiving payment.
5. RELEASE OF LIABILITY
Upon full payment, Creditor releases and forever discharges the Debtor and any guarantors from all claims relating to this debt.
6. BINDING AGREEMENT
This agreement is binding upon both parties and their respective successors and assigns.
7. SEVERABILITY
If any provision is deemed invalid, all remaining provisions shall remain in full force and effect.
8. ENTIRE AGREEMENT
This agreement represents the entire settlement agreement and supersedes all prior communications and understandings.
AGREED AND ACCEPTED:
CREDITOR:
Signature: _________________________
Print Name: _______________________
Title: _____________________________
Date: ______________________________
DEBTOR:
Signature: _________________________
Print Name: _______________________
Date: ______________________________

