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Exercise Extreme Caution when using many of our free forms - or any legal material. While they may provide general ideas on format & content, validity requirements can and do vary greatly from state to state. Many MUST be Properly Modified for your own location and circumstances. (Hint: If in doubt it's usually safer to include unneeded clauses than to leave out necessary ones. . . . but it's even safer to consult a competent source or use current, state specific ones like ours mentioned below.) Also, we urge people (and lawyers too) to read our Relying On Legal Info FAQ.

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FIFTEEN DAY RESTRICTIVE ENDORSEMENT NOTICE FORM LETTER

(Send this Before the check is sent! Get the letter back signed or send no check!)

(Debtors Full Name) (Street Address), (City, State & Zip)

(Credit Adjustment Agency) (Address) (City, State & Zip)

Date: Account Number(s):

IN Re: Credit Reporting Agency Disputed Item To Whom It May Concern,

This letter is to inform you I'll be sending your company a payment in 15 days from the date of your receipt of this letter. This payment is offered as part of our agreement to an Accord and Satisfaction of a disputed debt on the account(s) listed above. You only have 15 days which to object of accept or refuse this agreement before it expires. Acceptance may be by sending a certified letter to the above return address or by cashing my check. This new agreement will replace our old contract and obligations.

Upon endorsement or deposit of the above mentioned payment, you agree to payments of $(Enter Amount) for (Enter Months) months in order to satisfy this debt.

Upon receipt and deposit of first monthly payment under these new terms, you further agree to delete any negative items being reported to the 3 major credit bureaus regarding the above noted account, within 30 days, and mail me written notice of such deletion; and, You also agree to report this NEW account arrangement to all 3 major credit bureaus as current and being paid up to date with no late-payments or derogatory comments whatsoever, within 30 days, upon receipt of first monthly payment, you will correctly report how the new payments are being made under the new contract without references to the old contract; and,

In addition, you also agree to cease all collection or legal activity (if any) on the accounts in question and, in an effort to help me avoid bankruptcy, reduce my interest rate to an A.P.R. of (Enter Negotiated Amount) percent.

If this instrument of Accord is returned to me or refused after your receipt, there may not be any further settlement offers made on this account in the future and its' status will be in a state of dispute and I may seek counsel for a bankruptcy.

____________________________________ ______________________________
Authorized Representative Signature Print Name/Title Date

Sincerely,

Signature

Sent by Certified Mail Signature required for delivery

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