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Car Accident Payment Agreement Letter (Free Sample)
​Use this sample car accident payment agreement letter as a template for your formal agreement letter.
Last updated on September 14th, 2022


​Sample Payment Agreement Letter

​Name of Responsible Person
Address of Responsible Person
City, State, Zip Code

DATE

Name of Injured Party
Address of Injured Party
City, State, Zip Code

RE: offer of payment for repairs on the damaged car

Dear Name of Injured Party:

This is a formal letter of agreement for payment for the damage I caused to your car on DATE. I backed into the side of your car in the parking lot at ADDRESS and damaged the driver’s door. In our telephone conversation on DATE, we agreed that the full and final settlement amount for the cost of repair is AMOUNT.

​I agree to pay this amount with a personal check on or before DATE. Once this payment is made, you agree that I do not owe you any more money. 


When you sign this letter, you agree to release me from all present and future claims.

I have enclosed a copy of this letter for you to sign and return to me. Once we have both signed this letter, the agreement is final.

If you have any questions, or would like any changes in this letter, I can be reached at Phone Number or at Email Address. 

Sincerely,
​

Signature of Responsible Person
Printed Name of Responsible Person
List of Enclosures: Copy of the letter

___________________________
Signature of Injured Party with DATE

By Andre Bradley


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