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This letter will acknowledge that the contract or order is modified and superseded by the following agreed change in terms: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