Who Are You? I am the Party Owed ($)I Represent the Party Owed ($) Enter Your Name Also known as the "Creditor". Representative's Name Name of the Party representing the Party Owed ($) such as a Collection's Agency, Law Firm, Government Office, etc. Mailing Address Do you want to add your Mailing Address? Do you want to add your Mailing Address? YesNo Street Address City, State Zip Code Contact Want to add your Contact Information? Want to add your Contact Information? YesNo Phone, E-Mail, Website Phone Number E-Mail Website (optional) Representing Who are you Representing? Also known as the "Creditor". Date Date of this Demand Letter The Debtor Debtor's Name The person or company that owes the money. Debtor's Address Street Address City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Outstanding Balance Enter the Total Amount Owed $ Also known as the total Outstanding Balance. You can still offer a lower amount later if the Debtor pays within a certain time-frame. Reason for Debt Required to describe the reason for why the money is owed. Write the Reason for the Outstanding Balance: Write something as simple as an Account Number or write a Full Description of the reason for the outstanding balance. Discount Offer a DISCOUNTED AMOUNT if payment is made immediately? Offer a DISCOUNTED AMOUNT if payment is made immediately? Yes (recommended)No Discounted Amount $ If the Debtor pays the Discounted Amount the outstanding balance will be considered paid. To get the Discounted Amount, the Debtor must pay by Installments Want to offer Installment Payments as an option? Want to offer Installment Payments as an option? YesNo Installment Payments allow the debtor to pay the amount due on a weekly or monthly basis. Types of Installment Periods to Offer: (check all that apply) Types of Installment Periods to Offer: (check all that apply) WeeklyMonthly Minimum Payment per Week $/ Week This is the minimum payment the Debtor would have to pay on a weekly basis. Minimum Payment per Month $/ Month This is the minimum payment the Debtor would have to pay on a monthly basis. Final Notice Is this the Debtor's FINAL NOTICE? Is this the Debtor's FINAL NOTICE? YesNo Meaning if the Debtor does not pay within the suggested time-frame that legal action may be pursued or the amount owed will be sent to a collection's agency. Last Day The Last Day payment can be made by the Debtor before the amount is sent to a Collection's Agency or Legal Action is pursued. When is the LAST DAY payment can be made? Additional Terms Are there any Additional Terms or Conditions? Are there any Additional Terms or Conditions? YesNo If there are any other terms or conditions you would like to add this is your last chance. Enter any Additional Terms or Conditions: Electronically Sign Would you like to Electronically Sign this Letter? Would you like to Electronically Sign this Letter? YesNo Sign Your Name Clear Please draw your signature. Next Save Save and finish later
