The following is a sample of a debt settlement agreement.

(Creditor's name), the Creditor/Creditor's Representative and (your name), the Debtor agrees to negotiate and settle the debt under the following terms and conditions.

The Creditor and Debtor agree that the current outstanding debt is <$ (enter amount)>. Both parties agree that the Creditor will accept a cash payment of $____________ towards settlement of the debt in full. The Creditor agrees to compromise the debt under the condition that he'll receive the payment by (enter date).

If the Debtor fails to send in the amount agreed by the parties, then the Creditor shall immediately demand payment of the original amount owed by the Debtor. (Creditor's name) also declares that he/she is authorized to act as an agent of the Creditor's company.

This agreement for debt settlement shall be binding upon the Creditor, Debtor and their successors and assignees.

Dated:
Signature:

(Creditor's Name),
Creditor

(Your signature)
(your printed name)
Debtor