This agreement is made on {date} between {Debtor}, hereafter “Debtor,” and {Creditor}, hereafter “Creditor”:
Both parties acknowledge and agree that the Debtor currently owes {amount of money} to the creditor. Although this sum was originally due in full by {date}, the two parties now agree to the following terms and conditions:
The Debtor will be granted an extended debt payment period of {amount of time}. Therefore, he/she will pay {amount} every {frequency} until {date}.
The Debtor shall pay an interest rate of {interest rate} on the extended sum, for a total of {amount} by the final date.
Should the Debtor default on these terms, the Creditor is permitted to demand the remaining sum in full immediately. Should the defaulted sum result in a court appearance, the Debtor agrees to pay all associated legal fees.

Debtor _________________________ Date __________
Creditor _________________________ Date __________