Pursuant to that agreement between Enter the name of the property OWNER, described herein as OWNER and Enter the name of the CONTRACTOR, described herein as CONTRACTOR, dated Enter the date of the original contract the following change is made in the specifications and scope of work to be performed:

Enter a description of the change

This results in a The contract price will of the total contract price in the amount of $ Enter (in numerals) amount of change (Enter (words) amount of change dollars) and an adjusted total contract price of $ Enter (in numerals) total contract price after change (Enter (words) total contract price after change dollars.)

Date

Enter the name of the property OWNER, OWNER

Enter the name of the CONTRACTOR, CONTRACTOR