RESTRICTIVE ENDORSEMENT NOTICE

(Attach check to this A&S after sending 15-day letter)

Certified Mail # (Enter Number)

(Your Full Name)

(Street Address),
(City, State & Zip)

(Name of Creditor)
(Address)
(City, State & Zip)

Date:

Account Number(s):
To Whom It May Concern,
This attached letter is to confirm that you have accepted, based on your non-objection to my 15-
day restrictive endorsement notice, an offer of Accord & Satisfaction concerning the above noted
account. Upon endorsement of the attached payment instrument, you hereby agree to the
following:
Payments of $(Enter Amount) will be made on a monthly basis for (Enter Number) months, to
settle this account;
Upon endorsement of my first monthly payment, you hereby agree to report a new account as
“current” and “revolving”, with no negative marks whatsoever, upon receipt of final monthly
payment, within 30 days, respectively; and,
You, upon endorsement of first monthly payment, agrees to delete any negative items being
reported to the 3 major credit bureaus, within 30 days; and send me written notice of such
deletion; and,
You agree, in an effort to help avoid me falling into bankruptcy, charge a new A.P.R. of (Enter
Amount) percent; and,
Last but not least, you hereby agree to cease all collection on the account(s) noted in this new
agreement, unless debtor goes over 90 days into default on this Accord, which would render it
null and void.
If this payment and instrument of Accord is returned to me or refused after your receipt, no further
settlement offers or payments will be made on this account and its’ status will be in a perpetual
state of dispute.
Thank you for your immediate attention to this matter.

Sincerely,

Signature