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Debtor's Settlement Offer

If you would like to offer a settlement for a debt you have with a creditor, complete this form, print it and send it to the creditor to whom you owe the debt.

Click here for a sample. All information appearing in bold type and brackets are the form fields that would contain information specific to the parties involved and the debt being referenced.

Debtor (or Debtor Company Representative):
(Name of person signing this settlement offer for debtor company or just enter your name if you are contacting the creditor regarding a personal debt)
Debtor Company:
(Name of debtor company, if applicable. Leave blank if you are writing the creditor regarding a personal debt)
Debtor's Address:
(Your or your company's street address, depending on whether debt is personal or business)
City:
(Your city of residence or your company's city, depending on whether debt is business or personal)
State/Province:
(Select a state for U.S. clients or a Canadian province)
Zip/Postal Code:
Debtor (or Debtor Company) Country:
Creditor Company:
Accounts Receivable Representative:
(Name of contact person for creditor company, if known.)
Street Address:
(Street address of creditor company)
City:
State/Province:
(Select a state for U.S. clients or a Canadian province)
Zip/Postal Code:
Country:
Account Number:
(Account number of outstanding debt)
Balance:
(Current balance of debt)
Amount of Settlement:
(Indicate amount of money for which you want to settle the debt)
How Debt Will Be Paid:
(Indicate how you plan on settling the debt with the creditor company, e.g., 10 monthly installments of $200 payable on the 15th of each month until entire debt of $2000 is paid. Press <ENTER> twice to start a new paragraph.)
Governing State/Province:
(Select the governing state or Canadian province)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.