Today's Date

Your Name
Your Address

Attention: {Creditor's Name}
Credit Department
Creditor's Address

RE-. account #: {your account number here}

Dear Mr./Ms. {Collector's Name}

Thank you for speaking with me today about my temporary problem in making my normal payments, and for agreeing to the following payment arrangement on my account.

As agreed upon in our conversation, I will make a payment in the amount of:

$ _____ on or before the ______ of each month, until my payments are caught up or my account is paid off on ___________ (date).

(Or you can replace the above text with the following . . . )

As agreed upon in our conversation, I will not make a payment until ________ (date) at which time I will make payments in the amount of $ _____ on or before the ______ of each month, until my payments are caught up or my account is paid off on ___________ (date).

Thank you for your help and understanding.

Sincerely,

Signature just above printed name
Your Printed Name