Change Request Template

• Change Order No.

• Contract No.

• Job Name/ Number

• Job Location
  Address

• Change Requested By

• Date

  Date

• To (whom this is addressed)

• We, hereby agree to make the following change(s):

Planned Work

• Add work

work

• Work title

• Description of work to be done

• Attach/ Take photo of drawings and specifications needed for the planned work

  Media

• Reasons for change

• Take photo evidence of item/areas to modify

  Media

• List down estimated cost of labor and the necessary materials needed

• Total Estimated Cost

• Time Extension (if any)

Completion

• THIS CHANGE ORDER BECOMES PART OF AND IN CONFORMANCE WITH THE EXISTING CONTRACT

• We hereby agree to make the change(s) specified above at the price indicated per this Change Order.

• Name & Signature of Authorized Contractor

  Sign

• The prices and specifications of this Change Order are satisfactory and are hereby accepted. All work is to be performed under the established terms and conditions specified in the original contract unless otherwise specified.

• Name & Signature of Owner

  Sign