S REQUEST FOR ENGINEERING APPROVAL - PDF/Ford Supplier Request for... · date: 1-15-2005 supplier request…

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  • 1-15-2005DATE:

    SUPPLIER REQUEST FOR ENGINEERING APPROVAL

    ELECTRICAL COMPARTMENT 23456789PART NAME: PART NUMBER:

    QUALITY SYSTEMS ENGINEERINGSUPPLIER NAME AND ADDRESS

    4290 FLEXER DR

    SPRING HILL FL 3460742777690777SUPPLIER CODE:

    SUPPLIER TO COMPLETE

    USER DEFINE TEXTUSER DEFINEMISCINFROMATION

    DESIGN COMPOSITION WIEGHT PROCESSINGDESCRIPTION OF CHANGE:

    EFFECT OF CHANGE:YES NOYES NO

    ASSEMBLYCOMPONENTS

    WILL INCORPORATION OF CHANGEAFFECT SHIPPING SCHEDULE?

    YES NO

    TIME REQD TO INCORPORATED CHANGEAFTER APPROVAL

    SIGNATURE

    TOOLING OR FACILITY CHANGES REQUIREDIF YES, COST EFFECT $ YES NO

    PIECE COST AFFECTED YES NO

    IF YES, COST EFFECT $

    PRODUCT ENGINEERING TO COMPLETE

    SUPPLIER REPRESENTATIVE

    APPROVED* RELEASE ACTION REQ'D, NOTICE # REJECTED

    BY SIGNATUREDATE DATECONCURRED BY

    SIGNATURE

    BLANKET APPROVAL GRANTED FOR SUBSEQUENT CHANGESWHICH ARE SAME AS DESCRIBED ABOVE

    SUPPLIER CHECKLIST ATTACHED? SAMPLE OF CHANGED COMPONENT REQUIRED

    YES NO YES NO YES NO

    REASON FOR REJECTION OR QUALIFYING CONDITIONS OF ACCEPTANCE:

    REVIEWED BY:

    SQA DATE PURCHASING DATE

    * THIS APPROVAL IS GRANTED UPON THE UNDERSTANDING THAT IT IS ADVISORY IN NATURE AND IN NO MANNER CHANGES THE SELLERS ORIGINALRESPONSIBILITY FOR INSURING THAT ALL CHARACTERISTICS, DESIGNATED IN THE APPLICABLE ENGINEERING SPECIFICATIONS AND/OR INHERENT IN THESAMPLES AS ORIGINALLY TESTED AND APPROVED, ARE MAINTAINED. SELLER ACCEPTS FULL RESPONSIBILITY FOR THE CHANGES OR TYPES OF CHANGESLISTED ABOVE; AND ABOVE

    EMISSION CONTROLCODE NUMBER(SEE FORM74-107)

    CONTROL ITEMEFFECTEDYES NO

    USER DEFINE TEXT

    CEGJul 92 1638 ( Previous editions may NOT be used)

    145REF NO.:

    User is able to delete logo andchange title per (form) record,thus making a generic form.Users company logo can bepasted per record.

    4-4-2005Rev Date:3-1-2003Orig. Date: 2000 / 2005 All Rights Reserved - QSE Tel +1 810.499.1015 1.2Rev Level:

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