Project & Client Information
Customer Name
Job Site Address
Scope of Work Modifications
Description of Changes (Additions / Deletions)
Additional Materials & Specifications
Contract Financial Adjustments
Original Contract Amount
Sum of Previous Change Orders (if any)
Cost of THIS Change Order
Revised Total Contract Value
Timeline Impact
Schedule Adjustment
Terms & Acknowledgement
All terms, conditions, warranties, and code-compliance parameters established within the original contract remain in full effect unless explicitly amended within this Change Order document. Execution of this form authorizes the contractor to proceed with the modified scope immediately.
Authorized Signatures
CUSTOMER ACCEPTANCE
Signature Date: ____________
Print Name: ____________________________________
CONTRACTOR AUTHORIZATION
Signature Date: ____________
Authorized Representative