CHANGE ORDER (SCOPE OF WORK CHANGE)
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties to the Agreement
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This Agreement is entered into on ____________________ (____________________) by and between:

Client
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

Contractor
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
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Contract or Statement of Work (title and date):
    ____________________________________________________________________
Change Order Number: ___________________________________________________
Description of the Change: _____________________________________________
Price Adjustment: ______________________________________________________
Schedule Adjustment: ___________________________________________________

3. EXECUTION & SIGNATURES
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Client

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________

Contractor

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________