This Agreement on Disputed Account (the “Agreement”), is made and effective [EFFECTIVE DATE],
BETWEEN: [YOUR COMPANY NAME] (the "Creditor") a corporation organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at:
[YOUR COMPLETE ADDRESS]
AND: [DEBTOR NAME] (the "Debtor") a corporation organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at:
WHEREAS, Creditor asserts to hold certain claim against Debtor in the amount of [AMOUNT] arising from the below described transaction:
And whereas, Debtor disputes said claim, and denies said debt is due; And whereas, the parties desire to resolve and forever settle and adjust said claim.
Now, therefore, Debtor agrees to pay to Creditor and Creditor agrees to accept from Debtor simultaneous herewith, the sum of [AMOUNT] in full payment, settlement, satisfaction, discharge and release of said claim and in release of any further claims thereto.
Creditor acknowledges that there shall be no adverse report filed against Debtor with any credit bureau. This agreement shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives.
Executed under seal in duplicate on [DATE].
Signed, Sealed and Delivered in the Presence of
Authorized Signature Authorized Signature
Print Name and Title Print Name and Title