Fillable Form Payment Agreement Template

What is a Payment Agreement Template?

A Payment or Installment Agreement, or referred to as Payment Agreement Template is a legal document or contract between a creditor and a debtor to create an installment plan for repaying an outstanding amount over a certain time period. This document is usually used when the outstanding balance is too huge to be paid in full.

A Payment Agreement Template outlines the installment plan for paying a debt. It may include information such as:

• Payment periods
• Amount of payment
• Interest rates
• Deadline of payment
• Other terms and conditions

How to fill out a Payment Agreement Template?

For your convenience, PDFRun has a Payment Agreement Template that you can use. It should be filled out with the following information:

• The Parties

Agreement Date

Enter the date when the agreement will take effect.

The Creditor

Enter the full legal name of the creditor.

Mailing Address

Enter the complete mailing address of the creditor including the City, State, and ZIP code.

The Debtor

Enter the full legal name of the debtor.

Mailing Address

Enter the complete mailing address of the debtor including the City, State, and ZIP code.

• Balance

Enter the amount that the debtor owes the creditor in dollars.

Mark the appropriate box to determine the type of debt. You may select:

• An outstanding balance
• Property described as:
• Service described as:
• Other:

If you choose the second, third, or fourth option, enter the specific details.

• Discounted Balance

Mark the appropriate box to determine whether the creditor gives a discount to the debtor or not. You may select:

• No Discounted Balance. The Debtor shall pay the full Current Balance or Amount Owed.
• A Discounted Balance. The Debtor shall only be obligated to pay the discounted amount of (Number) Dollars. 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.

If you choose the second option, enter the amount of discounted amount in dollars.

• Repayment Plan

a.) Down-payment

Mark the appropriate box to determine how the debtor shall pay. You may select:

• Down-Payment of (Amount)
• No Down-Payment

If you choose the first option, enter the specific amount in dollars.

b.) Interest Rate

Mark the appropriate box to determine whether the amount owed will bear interest or not. You may select:

• Bear interest at a rate of (Percentage) compounded annually. The rate must be equal to or less than the usury rate in the State of the Debtor.
• Not bear interest.

If you choose the first option, enter the percentage of the interest rate.

c.) Repayment Period

Mark the appropriate box to determine the repayment period. You may select:

• Monthly basis beginning on (Date), in the amount of (Amount) to be paid on the (Day) of every month ending on (Date) or when the Amount Owed is paid-in-full.
• Bi-Weekly basis beginning on (Date), in the amount of (Amount) to be paid every fourteen days ending on (Date) or when the Amount Owed is paid-in-full.
• Weekly basis beginning on (Date), in the amount of (Amount) to be paid every seven days ending on (Date) or when the Amount Owed is paid-in-full.
• Other

If you choose the first option, enter the starting date, amount of debt in dollars, day of payment for each month, and the ending date.

If you choose the second or third option, enter the starting date, amount of debt in dollars, and the ending date.

If you choose the fourth option, enter the specific details of another repayment period.

d.) Payment Instructions

Enter a list of instructions that a debtor must follow when paying the creditor.

• Late Payment

Mark the appropriate box to determine how late payment will be treated. You may select:

• Not be allowed and consider the Debtor in default.
• Allow the Debtor to make payment within (Number) of days provided the Debtor pays a late fee of:

If you choose the second option, enter the allowed number of days for the extension period, and the amount of late fee.

If payment is not made within the extension period, this agreement shall be in default.

• Prepayment

Mark the appropriate box to determine the conditions of prepayment. You may select:

• 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:

If you choose the second option, enter the amount of penalty.

• Co-Signer

Mark the appropriate box to determine whether there will be a co-signer or not. You may select:

• This agreement shall not have a co-signer.
• This agreement shall have a co-signer known as (Name) 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.

If you choose the second option, enter the name of the co-signer.

• Default

This section includes the consequences and responsibilities of the debtor if he or she did not follow any section of the agreement and was deemed in default. It also indicates the rights of the creditor if there’s a breach of contract.

• Governing Law

Enter the state to determine the laws that will be applied to the agreement.

• Severability

This section includes that even if there’s any invalid provision, it will not affect the entire agreement; thus, the rest of the contract will remain effective.

• Additional Terms and Conditions

Enter a list of additional terms and conditions.

• Entire Agreement

This section includes how the agreement will be treated.

Debtor’s Signature Over Printed Name

Affix the signature of the debtor over his or her printed name.

Date

Enter the date when the debtor signed the agreement.

Co-Signer’s Signature Over Printed Name

Affix the signature of the co-signer over his or her printed name.

Date

Enter the date when the co-signer signed the agreement.

Creditor’s Signature Over Printed Name

Affix the signature of the creditor over his or her printed name.

Date

Enter the date when the creditor signed the agreement.