Disputed Account Settlement

Settlement Agreement by and between_______________________
of____________________(Creditor) and_____________________

Whereas, Creditor asserts to hold certain claim against Debtor in the amount of
$__________ arising from the below described transaction:

And whereas, Debtor disputes said claim, and denies said dept is due.

And whereas, the parties desire to resolve and forever settle and adjust said claim.

Now, therefore, Debtor agrees to pay to Creditor and Creditor agrees to accept from Debtor simultaneous herewith, the sum of _______________________
$__________ in full payment, settlement, satisfaction, discharge and release of said claim and in release of any further claims thereto. Creditor acknowledges that there shall be no adverse report filed against Debtor with any credit bureau.

This agreement shall be binding upon and inure to the benefit of the parties, their
successors, assigns and personal representatives.

Signed this _____ day of _______________________, 20____.