Debt Settlement Agreement This Debt settlement Agreement is by and between hereinafter referred as Creditor having its principal business office at and hereinafter referred as Creditor having it's principal business office at Recitals: The parties hereby agree to compromise the indebtedness between them based on the following terms and conditions: 1. The CREDITOR and the DEBTOR agree that the present debt due is <$ amount balance>. The parties agree that the Creditor shall accept the sum of <$ amount> as full payment on the debt. The payment will be made in cash and will result in complete discharge of the debt. 2. Both the parties have agreed on the date for payment as . If the DEBTOR fails to pay the agreed amount on , the original amount owed by the DEBTOR will stand to be due with immediate effect. is hereby authorized to act as the agent of the creditor agency. 3. The parties, their successors and the assignees are bound to abide by this agreement and the resulting benefits. 4. This Agreement shall be governed by and construed in accordance with the laws of United States of America, without regard to the application of principles of conflicts of law. The parties hereby consent to agree that the competent court in (insert the state name) shall have sole jurisdiction over any and all matters arising from this Agreement. Dated: Creditor's Signature: Name of creditor Debtor's Signature: Name of debtor In witness Whereof, the parties have caused this agreement to be executed the day and year first above written. Assignor : Name: Print Name: Address: Assignee : Name: Print Name: Address: I, the undersigned, a Notary Public in and for said County, in aforesaid state, Do hereby certify that Personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person, and acknowledged that signed, scaled and delivered the said instrument, as his/ her/their free and voluntary act, for the uses and purposes therein set forth. Given under my hand and notarial seal, this Signature of the Notary public (seal) Printed Name of the Notary public day of , 20 . American LegalNet, Inc. © www.FormsWorkFlow.com
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