A piece of paper with text on it, and blood dripping off the lower right edge.
Turns Isaac's body black, gives him small horns, and makes him seem more aggressive.
- The Pact seems to be signed in blood. In satanic rituals, a contract with a demon is usually signed with its conjurer's blood. See also: Pacts with the Devil.
- When playing as ???, if you have three Soul Hearts and take The Pact, you will still have two soul hearts remaining, but you will lose the game.