Potential change order cover

Subject: [Job] PCO [###] — [short description]

PCO [###]
Requested by: [name, company, date]
Location: [room / grid]
Description: [what is not in base scope]
Quantity: [SF / LF / EA]
Price: $[ ]  (see backup)
Time: [calendar days] additional / [none if none]

Please sign below to authorize. We will not proceed on this extra until written authorization is received.

Authorized by: ______________  Date: ________

• Hold field on the extra.
• Photo backup.
• Separate SOV line after execution.