HMC Change Order | PeakForms

HMC CHANGE ORDER:
DUMPSTER RENTAL

JOB #*
Customer Contact Information*
Name Phone Email
Property Address*
Street Address Address Line 2 City ZIP Code
ESTIMATOR/CONTRACTOR*
Date Signed*
MM slash DD slash YYYY
We hereby agree to make the change(s) specified below:*
Is Warranty Provided?*
- Yes
- No
Term of Warranty*
We agree to make the change(s) specified above at this price:*
Previous Contract Amount*
Revised Contract Total*
Authorized Signature (Estimator/Contractor):*
Date Signed*
MM slash DD slash YYYY
METHOD OF PAYMENT*
- CASH
- CHECK
- CREDIT CARD
The Owner agrees to pay the Price for the Change Order upon completion.
Check Number#*
If a check payment is returned for insufficient funds Owner agrees to pay Contractor a $50 return check fee plus any additional cost or fees incurred by the Contractor.
Credit Card Number*
Name of Cardholder as it appears on credit card:
Is Credit Card Billing Address Same As Property Address?*

Yes

No
Credit Card Billing Address*
Street Address Address Line 2 City State ZIP Code
Cardholder Signature
Please Note: By signing I am providing Peak Roofing Contractors Inc. authorization to run my credit card at the completion of my job.
ACCEPTED*
I have read, understand, and accept all terms of this agreement.
The above prices and specifications of this Change Order are satisfactory and are hereby accepted by homeowner (property owner).
All work to be performed under the same terms and conditions as specified in original contract unless otherwise stipulated.
Homeowner:
Signature Date
MM slash DD slash YYYY
Homeowner Signature:*
Email
This field is for validation purposes and should be left unchanged.