Form for Acknowledgement of Modified Terms : Please fill out the following form. Please print your completed form if you would to have a copy for your records.




Date :


To :


Dear Mr. XXXX,


Reference is made to the contract or order between us dated______.


This letter will acknowledge that the contract or order is modified and superseded by the following agreed change in terms:


(Enter the modified terms and conditions)


All other terms shall remain as stated.


Unless I/we immediately hear from you to the contrary, in writing, I/we shall assume said modification is mutually agreeable, and I/we shall proceed accordingly on the modified terms.


Please acknowledge same below and return one copy for my/our file.


Very truly yours,


_______________________


The foregoing modification is acknowledged :


_______________________





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