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Debt Settlement Agreement Letter

A debt settlement agreement letter can help a company resolve unpaid bills. For whatever reason, the debtor has an outstanding unpaid debt. A debt settlement agreement can help a company get back at least part of the money owed and recoup some loss. A debt settlement usually involves partial payments and reduction in the total amount owed. The letter is a contract signed by both parties.

Format and Content

The agreement must include the original debt owed, the new payment terms and the consequences if the debtor defaults on the agreement. The date the payment is due or when the partial payments are due should be included, along with how the payment should be made, either via check or cash, and amailing address should be provided. This letter is written from the company to the debtor and must be signed to make the agreement binding. The debt settlement agreement letter format is much like a contract.


This debt settlement agreement letter sample is from a doctor’s office to a patient with a six month old outstanding bill. After a phone call from the office, the patient said he or she could probably pay 75% of the costs over a four month period. This letter was drawn up and mailed to the debtor with the agreed upon amounts. The patient will review the letter, sign it, and return it to get his debt reduced.

Dear Mr Hayes:

We are aware that due to extenuating circumstances you have been unable to pay your bill with us for medical services. Please agree to the following terms to settle your debt with us.

Current Outstanding Debt: $2576.25 (please see itemized bill attached) for account number #3000921.This was originally due January 7, 2013.

Chiropractors of Baltimore agree to reduce the total debt by $576.25 to $2000, to be paid in four payments of $500 over the next four months. Each payment is due on the 1st of each month. The first payment will be due July 1, 2013. The final payment will be on October 1, 2013. These payments are acceptable by check or cash at our offices: Chiropractors of Baltimore c/o Dr. Lauren Booth, 823 Greenville Ave Baltimore, Maryland.


July 1, 2013: $500

August 1, 2013: $500

September 1, 2013: $500

October 1, 2013: $500

Total: $2000

If the debtor fails to complete one of these payments, the total amount will be due immediately.

Once paid, Chiropractors of Baltimore agrees to not press any further claim regarding the payment of received services up to this date. Any further medical services provided after this date are not subject to this agreement or any reduction in fee.

This agreement for debt settlement is agreed to by both parties and is valid on this date once both parties have signed.

Thank you for your responsiveness in this matter,

Rachel Brown

Manager with the offices of Dr. Lauren Booth

I have read and understood this agreement and voluntarily accept the terms.


William Hayes


Chiropractors of Baltimore