Simple Letter to Creditors for Payment Arrangements (Free Sample)

Your Name
Your Address
City, State, Zip Code

DATE

Creditor’s Name
Creditor’s Address
City, State, Zip Code

Dear [Creditor’s Name],

The purpose of this letter is to formally request a payment arrangement for the medical bills I owe your hospital.

I regret that I am unable to pay the bill in full at this time because my monthly income has been greatly reduced after the automobile accident in which I broke both of my legs.

I am requesting a payment plan of $100 per month until the time that I am able to continue working and receiving my usual salary. The rehabilitation may take from six to nine months.

At this time, my income is [Amount] and I have a home mortgage of [Amount] to pay. I will pay by check on the 18th of each month beginning [Date].

If this is agreeable to you, kindly send me a letter stating the repayment details as I have described. I can be reached at [555-123-4567] or a [name@email.com], and I would be happy to talk to you and give you more details at any time.

Sincerely,

Your Signature
Your Printed Name
List of Enclosures: