Therefore, in consideration for an additional loan to be made to a debtor, by a creditor,
and subject to any court approval which may be required by 11 USC Sec 524(c) or (d),
the debtor agrees to reaffirm the indebtedness, agrees that the indebtedness will survive
discharge, and agrees to repay the debt to the creditor, the reaffirmed indebtedness and
the additional indebtedness to be repaid in accordance with the following terms and
conditions: (specify terms).
In witness whereof, the parties have executed this agreement at ___________________
__________________________________ (specify place of execution) the day and year
first above written.
____________________________________________
Signature of Debtor
____________________________________________
Signature of Creditor