Attn: Customer Service
Name(s) on account: ____________________
Account number: _______________________
To Whom It May Concern:
I recently received a copy of my credit report from ____________. It lists my payments to you as
My past financial problems are behind me and I am now in a position to resolve this matter. [Choose on:] I
can pay a lump sum amount of $______/I can pay installments in the amount of $______ per month for
_______ months] if you will agree to do the following:
[ ] [if the amount of the debt is not disputed] If I make a lump-sum payment of $ ________ by ________,
20 __, you will release all claims against me arising from this account and will submit a Universal Data
Form to Experian, Equifax, and TransUnion deleting the account/trade line.
[ ] [if the amount of the debt is disputed] I dispute the amount of the debt. If I make a lump-sum payment
of $ ________ by ________ 20__, you will acknowledge that the balance owed on the account is $__[the
amount of the lump-sum payment]__, you will release all claims against me arising from this account, and
you will submit a Universal Data Form to Experian, Equifax, and TransUnion deleting the account/trade
[ ] [if you propose to make installment payments] If I agree to pay off the debt in installments, you agree to
re-age my account—that is, make the current month the first repayment month and show no late payments
as long as I make the agreed-upon monthly payments.
If my offer is acceptable to you, please initial the accepted proposal, sign the acceptance below, and return
this letter to me in the enclosed envelope.
Home phone: ____________________
Email address: ____________________
Agreed to and accepted on this _____ day of ______________.
Name (print): _____________________________