Debt rescheduling request template (US)

Request for a Payment Plan

Your Name

Your Address

Your Email or Phone

Date: Letter Date

To: Creditor Name

Department, such as Collections or Customer Accounts

Creditor Address

Re: Account number Account Number

Dear Sir or Madam:

I am writing to ask for a payment plan for my account. The current balance shown on my last statement is $Current Balance.

My Situation

I have fallen behind because of Reason, such as Job Loss, Reduced Hours, Medical Bills or Other Hardship, which began on Hardship Start Date. I want to pay this debt and avoid default, but I cannot pay the full amount now.

My Proposal

I propose to pay $Proposed Payment Amount per Payment Frequency, starting on First Payment Date, until the balance is paid. I can also make an initial payment of $Initial Payment on Initial Payment Date.

I also ask that you:

• waive or reduce late fees and penalty interest while I keep to the plan: Fee Waiver Request;

• stop collection calls and refrain from reporting the account as delinquent to credit bureaus while the plan is current, if you are able to.

Information Enclosed

I have enclosed Supporting Documents, such as a Budget or Proof of Income to show what I can afford.

Please send me your written response, including the terms of any plan you approve, to the address above. I will not treat any plan as agreed until I receive it in writing.

If this account has been placed with a debt collector, I understand I have rights under the Fair Debt Collection Practices Act, including the right to request validation of the debt.

Thank you for considering my request.

Sincerely,

Your Signature

Your Printed Name