Debt Collection Notice Letter

Debt Collection Notice and Repayment Agreement

Date of Notice:

Parties and Account Information

Account Number:    Original Principal: $    Last Payment Date:

Recitals

WHEREAS, Creditor represents that Debtor incurred a financial obligation reflected by the Account Number above and that the outstanding balance has not been paid as agreed; and

WHEREAS, Creditor asserts that the current total balance due on the account is $, consisting of principal, interest, fees, and lawful collection costs as identified in the Itemized Statement of Account; and

WHEREAS, the parties desire to set forth notice of demand and, where applicable, a repayment arrangement and the permitted collection actions and remedies available to Creditor.

Demand for Payment

This letter constitutes a formal demand for payment. Creditor demands payment in full of the outstanding balance in the amount of $ by no later than unless a written repayment agreement is executed below. Failure to pay or enter into a mutually agreed plan may result in lawful collection actions, including assignment to a collection agent, reporting to consumer reporting agencies, and legal remedies to recover the balance and costs of collection.

Scope of Collection Actions

Itemized Statement of Account

Provide a detailed breakdown of principal, interest, fees, and payments applied:

Payment Terms

Default; Remedies

If Debtor fails to make any payment when due or otherwise breaches the terms set forth in this notice or any executed repayment agreement, Creditor may declare the entire unpaid balance immediately due and payable and pursue available remedies including assignment to a collection agent, legal action to recover the balance, and recovery of reasonable costs of collection, including attorney fees where permitted by law.

Term and Termination

Term Commencement Date:    Term End Date (if any):

Notice of termination or material breach must be provided in writing and shall be effective upon receipt. The required notice period for termination for convenience or for breach is days.

Confidentiality

Except as required by law or regulation, the parties shall treat as confidential the terms of any repayment arrangement and any non-public information exchanged in connection with collection, and shall not disclose such information to third parties except to the extent necessary to effect collection, obtain legal advice, or comply with legal process.

Dispute and Validation Rights

Debtor has the right to dispute the validity of the debt or request verification. To dispute or request validation, Debtor must notify Creditor in writing within 30 days of receipt of this notice. If Debtor timely disputes, Creditor will provide written verification or a copy of the judgment, if any, within a reasonable time.

I dispute the debt as stated and request validation of the debt.

Governing Law; Entire Agreement

This Notice and any executed repayment agreement shall be governed by the laws of the state of without regard to conflict of law principles. This Notice constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior understandings and agreements, whether written or oral.

Acknowledgment and Acceptance

By signing below, Debtor acknowledges receipt of this Debt Collection Notice, acknowledges the accuracy of the information unless expressly disputed above, and agrees to the payment terms selected herein or as separately agreed in writing. Creditor acknowledges that any repayment plan accepted will be implemented in accordance with the terms set forth.

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