Pursuant to our telephone conversation on DATE, regarding your delinquent account this letter is to reiterate that conversation concerning the repayment of your account. You have agreed to remit an initial payment in the amount of $____ due by the ____ day of ______, 20__, and $____ will be due on or before the ____ day of each month thereafter until your account is paid in full. Checks or money orders should be made payable to the (name of state agency or school) and mailed to my attention at the above letterhead address.
Please be advised that if you fail to comply at the onset and/or should you fail to make your payments on a regular monthly basis this office will have no alternative but to obtain a judgment against you. If you have any questions regarding this repayment agreement please contact me at the above address or telephone number. If you agree with this repayment agreement, as stated in this letter, please sign at the designated place at the bottom of this letter and mail the original letter back to me along with your first payment. Please keep a signed copy for your files. Thank you for your attention to this matter.