CHANGE ORDER

Change Order #

Contract #

Date:

Construction Company

License No. 00000000

Address

City, State & Zip

Phone (000) 000-0000

Fax (000) 000-0000

Website

Email
Owner:
Address:
City:	State:	Zip:
Phone:	Fax:
Cell:	Other:
Email:
Job Location:

Description of the Changes and Description of the Significant Material to be Used and Equipment to be installed:

(Enter description starting here; delete this text)

Revised Approximate

Completion Date:

Pricing of additions/credits specified herein:	$

Previous Contract amount:	$

Revised Contract Total:	$0.00

The Schedule of Progress Payments will be affected in the following manner:

Amount Due	Work or services scheduled to be performed and materials and equipment to be supplied	Date Due
1. $
2. $
3. $
4. $

Accepted: The above pricing, all specifications, and changes to the schedule of progress payments of this Change Order are satisfactory and are hereby accepted. This Change Order becomes part of and in conformance with the existing contract. All work is to be performed under the same terms and conditions as specified in the original contract unless otherwise specified herein.

X	For:

Owner’s Signature	Date

X	X

Owner’s Signature	Date	Representative’s Signature	Date

Owner:	Page 1 of 1 - Change Order #

© 2012 www.amosprint.com

Lyle Workman

2012-07-25