Payment Agreement - Download Free Template
Payment Agreement

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I understand and agree that I am financially responsible for payment of all services received in the amount stated below. I agree to pay the amount in the time period stated below.

I understand that any remaining balance not paid in full will accrue a monthly service charge at [SPECIFY] % (minimum monthly service charge of [SPECIFY] $).

For professional services rendered or [SPECIFY], I agree to pay [YOUR COMPANY NAME] the total sum of [SPECIFY] $.


Customer name: _______________________________________________________

Customer address: ______________________________________________________

Account No: ____________________________________________

Payment amount: $_________________ Weekly / Bi-weekly / Monthly

First payment date _________________

Last payment date _________________


Payments shall be deemed delinquent if not received at the payment date. If any scheduled payment related to this agreement is deemed delinquent during the term of this agreement, the agreement shall be considered to be in default, and the entire amount, penalty, and interest owed shall be due and payable immediately.


___________________________________________ _________________

Client signature Date


____________________________________________ _________________

Staff Witness signature Date