DEVIATION REQUEST

TODAY'S DATE *

mm/dd/yyyy

Your E-mail (Requestor) Address *

Please enter your Company Name

[ PLEASE USE ALL CAPS HERE ]

Part # *

Part Name *

Part/Drawing Revision Level *

Quantity

PO Number, if known

Who is/are the buyer(s) for this product? *

Type to search

Is this a Blanket PO?

Yes

No

Please explain, very specifically, the change/deviation requested *

You may also upload a photo or file to further eplain the request

Drop your files here

Type of Deviation

DIMENSION

MATERIAL

PROCESS

OTHER

Please select one applicable Brand

Butech

Haskel

Hartell

Internal (Burbank)

N/A

*

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