Debt Acknowledgement Agreement Template

This Debt Acknowledgement Agreement (the “Agreement”) is entered into as of [Effective Date] by and between:

Creditor: [Creditor Full Legal Name], address: [Address] (“Creditor”).
Debtor: [Debtor Full Legal Name], address: [Address] (“Debtor”).

Creditor and Debtor may be referred to individually as a “Party” and collectively as the “Parties.”

1. Acknowledgement of Debt

1.1 Debt Amount. Debtor acknowledges owing Creditor the total amount of $[Amount] (the “Debt”).
1.2 Source of Debt (Optional). The Debt arises from: ☐ Loan ☐ Invoice(s) #[__] ☐ Services rendered ☐ Settlement ☐ Other: [Describe].
1.3 No Dispute. Debtor acknowledges the Debt is valid and currently due, except as modified by the payment terms below.

2. Payment Terms

2.1 Payment Option (Select One):
☐ Lump sum payment of $[Amount] due on [Due Date]
☐ Installments of $[Amount] per ☐ week ☐ month, starting [Start Date], with final payment due [Final Due Date]
☐ Other schedule: [Describe]

2.2 Payment Method. ☐ Bank transfer ☐ Check ☐ Cash ☐ Other: [Method].
2.3 Payment Destination. Payments will be made to: [Account/address].

3. Interest (Optional)

3.1 Interest Rate. ☐ No interest ☐ Interest at [__]% per year.
3.2 If the stated rate exceeds the maximum allowed by law, it will be reduced to the maximum permitted.

4. Late Fees (Optional)

4.1 Payment is late after [] days.
4.2 Late fee: $[] or [__]% (if permitted by law).

5. Default and Remedies

5.1 Default. Default includes failure to make a payment when due or other material breach.
5.2 Notice and Cure (Optional). Debtor has [__] days to cure after written notice.
5.3 Acceleration. Upon default, Creditor may declare the entire remaining balance immediately due, subject to applicable law.
5.4 Collection Costs. Debtor will pay reasonable collection costs and attorneys’ fees where permitted.

6. Release Upon Payment (Optional)

6.1 Upon full and cleared payment of the Debt (including any agreed interest/fees), Creditor will provide written confirmation that the Debt is satisfied.

7. No Waiver

7.1 Acceptance of partial or late payments does not waive Creditor’s rights unless agreed in writing.

8. Governing Law

8.1 This Agreement is governed by the laws of [State/Country].

9. Notices

9.1 Notices must be in writing and delivered to the addresses listed above.

10. Entire Agreement

10.1 This Agreement is the entire agreement regarding the Debt and replaces prior discussions.

Signatures

By signing below, the Parties agree to this Debt Acknowledgement Agreement as of the Effective Date.

Creditor: [Full Name]
Date: [Date]
Signature: ___________________________

Debtor: [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (Optional)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Creditor Name] and [Debtor Name], known to me (or satisfactorily proven) to be the persons whose names are subscribed to this Agreement, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________