Reaffirmation Agreement

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REAFFIRMATION AGREEMENT
This agreement made, effective as of __________, by and between ________________
______________________________, of _____________________________________
____________________________ (Address), in the County of ___________________,
referred to as the creditor, and __________________________, of ________________
______________________________ (Address), in the County of _________________,
referred to as the debtor.
The parties agree as follows:
SECTION ONE
BANKRUPTCY OF DEBTOR
On ___________________ (Date), a petition for relief under Chapter _____________
of Title 11 of the United States Code was filed ___________________ (By or Against)
the debtor in the Bankruptcy Court for the District of __________________. On the
date of the filing of such petition, debtor was, and still is, indebted to creditor for
___________ ________ Dollars ($__________), _____________________________
______________________________________________________________________
_______________________________________________________ (description of the
basis of the debt, i.e.; on a written promissory note dated ___________).
SECTION TWO
NEW PROMISE TO PAY DEBT
The debtor fully understands the fact that debtor would be entitled to discharge of this
indebtedness when and if a discharge is granted in the pending proceedings, but wishes
to repay the debt in partial consideration for an additional loan that a creditor desires to
make to the debtor.

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