PAYMENT AGREEMENT  
 Agreement made this _______ day of _______________________, __________.  
 BETWEEN , doing  business at (hereinafter referred  to as the “Landlord”) and  
residing at (hereinafter referred to as the  “Tenant”).  
WITNESSETH  
 WHEREAS, the Landlord and the Tenant entered into a lease agreement dated   for Apartment Number at  
 ; and  
 WHEREAS, the Tenant has breached said lease agreement by failing to pay rent and  other charges.  
 1. Tenant acknowledges being indebted to Landlord for $ as  follows:  
 A. Legal Fees (preparation of Three Day Notice) $   B. Process Server (Three Day Notice) $   C. Rent for the Months of $   D. Late Charges for the Months of $   E. Bad Check Charges $  
 TOTAL $  
 2. Tenant shall pay the above balance of $ at the offices of  Landlord in the form of a money order or certified funds as follows: $ per  month/week on the _______ day of each and every month/week commencing on   , .  
 3. If Tenant fails to pay the amounts owing as set forth in paragraph number two,  Landlord may commence eviction proceedings without further notice to Tenant.  
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4. Simultaneously with the execution of this agreement, Tenant shall sign an  Affidavit for Confession of Judgment. Said Affidavit will be filed with the court without prior  notice to Tenant if Tenant defaults under this agreement.  
 5. Tenant acknowledges that he/she is satisfied with the condition of his/her  apartment.  
 6. Tenant understands that this document is an attempt to collect a debt and any  information obtained will be used for that purpose.  
 7. Tenant has read this agreement and understands its terms.  
 8. This agreement in no way limits or waives the conditions set forth in the lease  agreement. The Tenant acknowledges that said lease agreement is still in full force and effect and  is unmodified.  
 9. Tenant has no defenses or offsets to said lease agreement.  
 __________________________________________   Landlord  
 __________________________________________   Tenant  
 __________________________________________   Tenant  
A:62 
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LegalSurvival.com 
74 Main St., PO Box 31, Akron, NY 14001, Phone: (716) 542-5444, rfriedman@legalsurvival.com