CHANGE ORDER
Contractor
License #
Phone / email
Change order #
Date
Original contract date
Job / contract #
Starting point only, not legal advice. Some states set specific change order requirements for home improvement work; have a local attorney review your form.
Owner and project
Owner name
Phone / email
Project address
Project description
Reason for change
☐ Owner request ☐ Hidden or unforeseen condition ☐ Code or inspector requirement ☐ Design change ☐ Other: ______
Description of change
[Exactly what work is added, removed or changed, with location, materials and quantities]
Price of change
| Item | Qty | Rate | Amount |
|---|---|---|---|
| Labor | |||
| Materials | |||
| Equipment / subcontractor | |||
| Other (disposal, permit) |
| This change order (+ / −) | |
| Original contract price | |
| Previous change orders (net) | |
| NEW CONTRACT TOTAL |
Schedule and payment
Schedule impact[+/- ___ working days; new completion date ________]
Payment[Due with next progress payment / due on completion / due before work starts]
Agreement
This change order becomes part of the contract named above. All other terms of that contract stay the same. Work described here will not begin until both parties sign.
Owner signature
Printed name
Date
Contractor signature
Printed name
Date
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