Creditor Repayment Agreement for Account

[Date]

Creditor                                              *****SENT VIA CERTIFIED MAIL*****

City, State, Zip

RE:   REPAYMENT AGREEMENT FOR ACCOUNT

Dear [name]:

Thank you for speaking with me on [date] regarding my account. As discussed, I have been prompt in paying in the past, but have recently been late due to the following circumstance(s):

I am requesting an amended repayment agreement until my financial situation improves. I would like to pay $[amount] for the next [number] payment periods. After that time, I agree to resume making my full monthly payments.

I understand that during this time I will not be using any credit with [company name].

If my situation changes, I will contact you immediately.

Thank you for your understanding and assistance with this matter. If you have any questions or need additional information, please contact me at the address listed below.

Sincerely,

Bruce Smith

Address

City, State, Zip