STRUCTURED DEBT REPAYMENT PLAN AGREEMENT
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties to the Agreement
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This Agreement is entered into on ____________________ (____________________) by and between:

Lender / Creditor
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

Borrower / Debtor
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
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Total Amount Owed: _____________________________________________________
Installment Amount: ____________________________________________________
Payment Schedule: ______________________________________________________
First Payment Date: ____________________________________________________
Missed Payment Arrangements: ___________________________________________

3. EXECUTION & SIGNATURES
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Lender / Creditor

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________

Borrower / Debtor

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________