Additional Charge (AC) Form
(Change Order or Track Changes Document)

Project Title:		
Project ID:		
Date:		
		
Client Name:		
Client Email:		
Client Phone:		
		
[company] contact:		

This item is a:	1. Client-requested change
2. Additional item request
3. Outside original budget/scope
4. Other___________________________________	
Description of change or addition:	

	

Description of Services	Estimated Hours	Cost	
		$	
		$	
		$	
	Total	$	

I am in agreement with the additional charge, description, timeline, and details outlined above. Please sign the document below and fax back to [xxx-xxx-xxxx].

Client Signature		Date	

Client Name (printed)			

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