Supplier Deviation Form

Please take a few minutes to fill out the following information.

Date: Dec 21, 2024

Type of Request:

Temporary:

Permanent:

Vendor:

P.O. #:

Part #:

Rev #:

Due Date:

Part Description:

Qty. Ordered:

Deviation Qty.:

Contact:

Phone:

Fax:

Reason for request:* (If requesting a Material Deviation, a copy of the material cert must be attached showing the characteristic the request is being written for. If requesting a Tolerance Deviation, a copy of the print must be attached showing the dimension the request is being written for.)

Affects:

Material

Dimension/Tolerance

Finish

Performance

Request:

Deviation

Engineering Change

All of the above information must be completed for deviation consideration. Deviations must not affect the function of a part or the ability to retrofit the part. A signed copy of this deviation must accompany parts at delivery. An approved deviation is for this part (batch) and does not cover future orders with similar defects unless otherwise stated. If deviation significantly reduces production costs or shortens lifespan of a given part, a price review may be requested by D.L.Martin Co. I understand all terms of this concession.

Name

Title

Attach a file