Fillable PAYMENT (INSTALLMENT) AGREEMENT

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PAYMENT (INSTALLMENT) AGREEMENT

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The PAYMENT (INSTALLMENT) AGREEMENT form is 3 pages long and contains:

  • 3 signatures
  • 20 check-boxes
  • 54 other fields

Country of origin: OTHERS
File type: PDF

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Page 1 of 3
PAYMENT (INSTALLMENT) AGREEMENT
I. THE PARTIES. This Payment Installment Agreement (“Agreement”) dated
__________________, 20____, is by and between:
Creditor: __________________, with a mailing address of __________________, City of
__________________, State of __________________, Zip _________ (“Creditor”), and
Debtor: __________________, with a mailing address of __________________, City of
__________________, State of __________________, Zip _________ (“Debtor”).
HEREINAFTER, the Debtor and Creditor (“Parties”) agrees to the following:
II. BALANCE. At the time of this Agreement, the Debtor owes the Creditor the amount of
__________________ Dollars ($_________) (“Current Balance”) for: (check one)
☐ - an Outstanding Balance.
☐ - Property described as: ______________________________________________________.
☐ - Service described as: ______________________________________________________.
☐ - Other: ___________________________________________________________________.
III. DISCOUNTED BALANCE. In consideration of the Debtor’s faith to repay the Current
Balance in this Agreement, the Creditor agrees to: (check one)
☐ - No Discounted Balance. The Debtor shall pay the full Current Balance (“Amount Owed”).
☐ - A Discounted Balance. The Debtor shall only be obligated to pay the discounted amount of
__________________ Dollars ($_________) ("Amount Owed"). If the Debtor should default
under any of the terms of this Agreement, the Debtor shall owe the Creditor the Current Balance
in addition to other penalties, fees, and any accumulated interest.
IV. REPAYMENT PLAN. To satisfy the Amount Owed, the Debtor agrees to repay the Creditor
under the following terms:
a.) Down-Payment. The Debtor shall pay: (check one)
☐ - Down-Payment of $_________.
☐ - No Down-Payment.
b.) Interest Rate. The Amount Owed shall: (check one)
☐ - Bear interest at a rate of _______________ percent (____%) compounded
annually. The rate must be equal to or less than the usury rate in the State of the
Debtor.
☐ - Not bear interest.
Page 2 of 3
c.) Repayment Period. The Debtor shall re-pay the Creditor on a: (check one)
☐ - Monthly basis beginning on __________________, 20____, in the amount of
$_________ to be paid on the ____ of every month ending on
__________________, 20____ or when the Amount Owed is paid-in-full.
☐ - Bi-Weekly basis beginning on __________________, 20____, in the amount
of $_________ to be paid every fourteen (14) days ending on
__________________, 20____ or when the Amount Owed is paid-in-full.
☐ - Weekly basis beginning on __________________, 20____, in the amount of
$_________ to be paid every seven (7) days ending on __________________,
20____ or when the Amount Owed is paid-in-full.
☐ - Other. _______________________________________________________.
d.) Payment Instructions. The Debtor is required to pay the Creditor under the following
instructions:
_____________________________________________________________.
V. LATE PAYMENT. Any partial or late payment under this Agreement shall: (check one)
☐ - Not be allowed and consider the Debtor in default.
☐ - Allow the Debtor to make payment within ____ days provided the Debtor pays a late fee of:
___________________________________________________________ (“Extension Period”).
If payment is not made within the Extension Period, this Agreement shall be in default.
VI. PREPAYMENT. The Debtor may: (check one)
☐ - Pre-pay the Amount Owed without penalty.
☐ - Not prepay the Amount Owed. If the Debtor decides to prepay the Amount Owed, the
Debtor shall pay the penalty of: __________________________________________________.
VII. CO-SIGNER. (check the appropriate box)
☐ - This Agreement shall not have a Co-Signer.
☐ - This Agreement shall have a Co-Signer known as __________________ hereinafter known
as the "Co-Signer” and agrees to the liabilities and obligations on behalf of the Debtor under the
terms of this Agreement. If the Debtor does not make a payment, the Co-Signer shall be
personally responsible and therefore is guaranteeing payment of the principal, late fees, and all
accrued interest under the terms of this Agreement.
VIII. DEFAULT. If for any reason the Debtor should not oblige to any section or portion of this
Agreement, the Debtor shall be considered in default. Under such an event, the remaining
balance of the Amount Owed shall be due within five (5) business days with the Debtor liable to
pay all reasonable attorney's fees and costs of collection of the Creditor. In addition, the Creditor
may reclaim any property or goods in connection with the Amount Owed, hold and dispose of
the same, and collect expenses, together with any deficiency due from the Debtor, subject to the
Debtor's right to redeem said items pursuant to law.
Page 3 of 3
IX. GOVERNING LAW. This Agreement shall be governed by, and construed in accordance
with, the laws of the State of ___________________ (“Governing Law”).
X. SEVERABILITY. The unenforceability or invalidity of any clause in this Agreement shall not
have an impact on the enforceability or validity of any other clause. Any unenforceable or invalid
clause shall be regarded as removed from this Agreement to the extent of its unenforceability
and invalidity. Therefore, this Agreement shall be interpreted and enforced as if it did not contain
the said clause to the extent of its unenforceability and invalidity.
XI. ADDITIONAL TERMS & CONDITIONS.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
XII. ENTIRE AGREEMENT. This Agreement contains all the terms agreed to by the Debtor and
Creditor relating to its subject matter, including any attachments or addendums. This
Agreement replaces all previous discussions, understandings, and oral agreements.
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the undersigned
dates written below.
Debtor’s Signature: ____________________________ Date: _________________
Print: ____________________________
Co-Signer’s Signature (if any): ____________________________ Date: _________________
Print: ____________________________
Creditor’s Signature: ____________________________ Date: _________________
Print: ____________________________
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PAYMENT (INSTALLMENT) AGREEMENT

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Completed 15 January 2021

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