Fill and Sign the Reaffirmation Agreement Sample Form

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI Case No.       Acct. No.       REAFFIRMATION AGREEMENT The debtors listed above hereby agree to repay pursuant to the terms of the original instrument of their obligation, or any additional terms as required by , listed in Paragraph 5. NOTICE TO DEBTORS: THIS AGREEMENT MAY BE RESCINDED BY YOU AND ANY TIME PRIOR TO THE DISCHARGE GRANTED BY THE BANKRUPTCY COURT OR WITHIN 60 DAYS AFTER THIS AGREEMENT IS FILED, WHICHEVER EVENT OCCURS LATER, BY YOUR GIVING NOTICE OF YOUR DECISION TO THE CREDITOR. IF YOU WISH TO RESCIND THIS REAFFIRMATION AGREEMENT SEE YOUR ATTORNEY IMMEDIATELY. 1. The NET PAYOFF on the obligation as of is $ PLUS interests occurring at the present rate of       % 2. The collateral being held as security is: 3. Monthly installments in the amount of $ with the next payment will be made on or before the       of each month, and continue until the obligation is paid in full which may include all applicable charges and/or credits pursuant to the terms of the original contract which established this debt. 4. Debtors further understand that this agreement is not required under law and that this agreement is completely voluntary and is in accordance with 11 U.S.C. sec. 524 (c). 5. OTHER:       6. Debtor must maintain comprehensive, fire, theft, and collision insurances on said property. 7. In the event of default of the terms of this agreement, or the terms of the original instrument of indebtedness the debtors shall relinquish all rights to possession of the security listed in paragraph 2. The foregoing terms are mutually agreed upon and accepted this ______________ Day of ______________ 20 _____ by: __________________________________ Bankruptcy Specialist _______________________________________ Debtor