Disputed account settlement
Disputed account settlement form
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 dept 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
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More forms in this category:
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Demand for payment
Disputed account settlement
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