Debt Acknowledgment Template

DEBT ACKNOWLEDGMENT / IOU

Date: Date

DEBTOR INFORMATION

Name: Debtor Full Name

Address: Debtor Address

Phone: Phone

Email: Email

CREDITOR INFORMATION

Name: Creditor Name

Address: Creditor Address

Phone: Phone

Email: Email

ACKNOWLEDGMENT OF DEBT

I, Debtor Name, hereby acknowledge that I owe Creditor Name the sum of:

Amount Owed: Currency Amount in Numbers

Amount in Words: Amount Spelled Out

ORIGIN OF DEBT

This debt arose from: Detailed description of how the debt was incurred - loan, goods purchased, services rendered, etc.

Original Date of Debt: Date

Original Amount (if different): Amount

DEBT BREAKDOWN (If Applicable)

Principal Amount: Amount

Interest Accrued: Amount at Rate%

Fees/Charges: Amount

Payments Made: - Amount

Current Balance Due: Amount

PAYMENT HISTORY

| Date | Amount Paid | Balance Remaining | |------|-------------|-------------------| | Date | Amount | Balance | | Date | Amount | Balance |

PAYMENT TERMS

Repayment Plan:

Option 1 - Lump Sum:

• Full amount due on Date

Option 2 - Installment Plan:

• Amount per Week/Month
• First payment due: Date
• Subsequent payments due: Day of each Month/Week
• Final payment due: Date

Payment Method:

• Specify payment method

INTEREST

Interest Rate: Percentage% per Year/Month

Interest Accrues: From original date From Date No interest

Interest Calculation:

Simple Interest Compound Interest No Interest

LATE PAYMENT

Late Fee: Amount or Percentage if payment is more than Days late

Grace Period: Number days

SECURITY/COLLATERAL (If Applicable)

This debt is:

• Unsecured
• Secured by: Description of collateral

DEFAULT

I will be in default if:

• I fail to make a payment when due
• Other default conditions

CONSEQUENCES OF DEFAULT

Upon default, the Creditor may:

• Declare entire balance immediately due
• Take possession of collateral, if secured
• Pursue legal remedies
• Charge collection costs and attorney fees

CONFESSION OF JUDGMENT (If Applicable)

In the event of default, I authorize entry of judgment against me for the amount due plus costs and fees.

RIGHT TO PREPAY

I may may not prepay this debt without penalty.

WAIVER

Creditor's delay in enforcing rights does not waive those rights.

MODIFICATION

This acknowledgment may only be modified in writing signed by both parties.

GOVERNING LAW

This acknowledgment shall be governed by applicable laws.

DECLARATION

I acknowledge that:

• I owe the debt described above
• The amount and terms are correct
• I am obligated to repay according to these terms
• I understand the consequences of non-payment
• I am signing this voluntarily

DEBTOR SIGNATURE:

I acknowledge this debt and agree to the repayment terms.

Signature: _______________________

Print Name: Debtor Name

Date: _______________________

CREDITOR SIGNATURE:

I acknowledge this debt acknowledgment.

Signature: _______________________

Print Name: Creditor Name

Date: _______________________

WITNESS:

Witness:

Signature: _______________________

Print Name: Witness Name Address: Address

Date: _______________________

NOTARIZATION (Recommended):

Subscribed and sworn to before me on Date.

Notary Public: _______________________

Commission Number: Number My Commission Expires: Date

NOTARY SEAL