Here we see some examples of letter
of intent to pay debt. You should modify this letter to be suitable for your
purpose and situation.
Sample
letter of intent to pay debt
Dear Mr.
Mark,
Under our
original agreement, my deadline to settle my outstanding balance of $1,600 is
on June 15, 2012. Due to unforeseen circumstances concerning my health, I am
unable to make payments on the said date. I would kindly like to request for a
two (2) week extension to settle the matter.
In good
faith, I am making a small payment of $500 today which would leave me at a
balance of $1100 to your company. I am doing what ever I can to clear my debt.
Hoping for
your consideration.
Sincerely,
Mrs. Sara
letter of
intent to pay debt template
Date
Name
Contracts Manager
Agency/Department
Address
Re: Letter of Intent to pay for ………….
services for fiscal year 2013/06
)FY
05/06(
The County of ………….Mental Health
Department agrees to pay ……….. for services at ………. (agency or facility) for FY
05/06. The interim rates agreed to are as follows:
1- The FY 05/06 interim rate for
Medi-Cal eligible placements is $.......... per patient day.
2-The FY 05/06 interim
rate for non-Medi-Cal eligible placements is $........per patient day.
AFDC-FC payment flow between County
of ……..….Mental Health Department and …….…….
will be independent of this agreement.
This agreement will be in effect
until a fully executed contract is in place, and reimbursement will be on a fee-for-service
basis. Within 12 months following June 30, 2006, ……. will reconcile all costs
with (agency……. and will provide County of …………. Mental Health with results of
this reconciliation*. This reconciliation will determine actual rates and
utilization by payer type for FY 05/05 and (agency or county) will either
submit an additional invoice to County of ………………
Mental Health, if the rate is higher, or reimburse
County of …………………….
Mental Health, if the rate is lower.
Sincerely,
Name
______________County Mental Health
* The
reconciliation will be done in accordance with
______________________________________
)Short/Doyle
regulations or other appropriate reference(
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Related searches: Related
searches: Example Request For Extension Letter, Intent to Pay Letter, Intent
to Settle Letter template, Promissory Note for Debt Notice, Promissory Note
letters,, pay outstanding debt,
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