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*Thirty (30) Day WarrantySixty (60) Day WarrantyNinety (90) Day WarrantyOne (1) Year WarrantyTwo (2) Year WarrantyThree (3) Year WarrantyFour (4) Year WarrantyFive (5) Year WarrantyWe 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cardholder SignaturePlease 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:*EmailThis field is for validation purposes and should be left unchanged.
