Bankruptcy 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:


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 ___________).


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.

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

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