DISPUTED ACCOUNT SETTLEMENT

Settlement Agreement by and between ____________________________________ of ____________________________________ (Creditor) and ____________________________________ of ____________________________________ (Debtor).

Whereas, Creditor asserts to hold certain claim against Debtor in the amount of $__________ arising from the below described transaction:

And whereas, Debtor disputes said claim, and denies said debt is due.

And whereas, the parties desire to resolve and forever settle and adjust said claim.

Now, therefore, Debtor agrees to pay to Creditor and Creditor agrees to accept from Debtor simultaneous herewith, the sum of _______________________ $__________ in full payment, settlement, satisfaction, discharge and release of said claim and in release of any further claims thereto. Creditor acknowledges that there shall be no adverse report filed against Debtor with any credit bureau.

This agreement shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives.

Signed this _____ day of _______________________, 20_______.

Witnesseth:

______________________________        ______________________________
Witness                                                        Creditor

______________________________        ______________________________
Witness                                                        Debtor

Other Forms You May Need

* Authorization to Release Credit Information
* Letter Requesting Authorization to Release Credit Information
click to download Disputed Account Settlement template
                            

Other legal template form