Legal & declarations
Acknowledgment of debt template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Preview — US standard
Acknowledgment of Debt
This Acknowledgment of Debt is made on Acknowledgment Date by Debtor Name, residing at Debtor Address ("Debtor"), in favor of Creditor Name, at Creditor Address ("Creditor").
1. Acknowledgment
Debtor acknowledges and agrees that, as of Balance Date, Debtor owes Creditor the sum of $Amount Owed (Amount in Words dollars) (the "Debt"), arising from Source of the Debt, such as a Loan Made on (Date), Unpaid Invoices or Goods Sold, and that the Debt is valid, due, and not subject to any defense, offset or counterclaim, except: Exceptions, or None.
2. Promise to Pay
Debtor promises to pay the Debt to Creditor as follows:
Payment schedule: Number of Payments payment(s) of $Payment Amount each, due on the Payment Due Day of each month starting First Payment Date, with the full Debt paid by Final Payment Date.
Payments will be made by Payment Method to Payment Address or Account.
3. Interest
Interest: unpaid amounts bear interest at Interest Rate% per year, not to exceed the highest rate allowed by law. Enter 0% if no interest will be charged while payments are made on time.
4. Default
If Debtor misses a payment and does not pay within Grace Days days after written notice, Creditor may declare the entire unpaid balance due at once, and may recover reasonable costs of collection, including attorney's fees where the law allows.
5. Statute of Limitations
Debtor understands that this signed acknowledgment may restart or extend the time within which Creditor may sue to collect the Debt under the law of the governing state.
6. Prepayment
Debtor may prepay all or part of the Debt at any time without penalty.
7. General
This Acknowledgment is governed by the laws of the State of Governing State. It binds Debtor's heirs and estate. If any part is unenforceable, the rest stays in effect. Creditor's delay in enforcing any right is not a waiver.
| Debtor | Creditor |
| --- | --- |
| Signature: Debtor Signature | Signature: Creditor Signature |
| Name: Debtor Printed Name | Name: Creditor Printed Name |
| Date: Debtor Signing Date | Date: Creditor Signing Date |