To fill out this letter, clearly write your name and address at the top. Include the date and the collection agency's name and address.You can fill in the appropriate information and mail this to the debt collection agency harassing you. Sample Cease and Desist Letter: Insert date. If a creditor has refused your offer of payment then you can use the Reconsider my pro-rata offer sample letter to ask them to reconsider. Request to begin debt settlement negotiations. If the collection agency or creditor rejects your offer, don't lose hope. Reject or accept settlement offers on your behalf. How to use this sample letter: 1. Read the background below. 2.