Fill and Sign the Extend Debt Form

Agreement to Extend Debt Payment Agreement made on the ________________________ (date) , between ________________________ (Name of Creditor) of _________________________________ ______________________________ (street address, city, county, state, zip code), referred to herein as Creditor , and ___________________________ (Name of Customer) , of ____________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Customer . Whereas, the Customer and the Creditor acknowledge that the Customer is indebted to the Creditor in the sum of $______________, (the Debt) , which sum is now due and payable; and Whereas, Creditor agrees to extend the term for payment of the Debt . Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Creditor agrees to the payment of the Debt on extended terms, together with interest on the unpaid balance at the rate of __________% per annum, payable in the following manner: (State Payment Terms) _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. 2. Customer agrees to pay the Debt to the Creditor together with interest thereon under the terms set out in Paragraph 1 . 3. In the event that the Customer shall fail to make any payment on the due date, the Creditor shall have full rights to collect the entire balance then remaining which amount shall be immediately due and payable. 4. In the event of default, the Customer agrees to pay all reasonable solicitors’ fees and costs of collection. 5. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 6. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of ______________. 7. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 8. Attorney’s Fees In the event that any lawsuit is filed in relation to this Agreement, the unsuccessful party in the action shall pay to the successful party, in addition to all the sums that either party may be called on to pay, a reasonable sum for the successful party's attorney fees. 9. Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 10. Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 11. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 12. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 13. This Agreement shall be binding upon and inure to the benefit of the parties, their successors and assigns. WITNESS our signatures as of the day and date first above stated. ________________________ _________________________ (P rinted name) (P rinted name) ________________________ _________________________ (Signature of Creditor) (Signature of Customer)