DEVIATION REQUEST

DEVIATION REQUEST

TODAY'S DATE*

Your E-mail (Requestor) Address*

Please enter your Company Name

[ PLEASE USE ALL CAPS HERE ]

Part #*

Select or enter value

Part Name*

Part/Drawing Revision Level*

Quantity

PO Number, if known

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

Select

Is this a Blanket PO?

Yes

No

How long is the Blanket PO duration period?

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

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

Drag and drop files here or

Type of Deviation

DIMENSION

MATERIAL

PROCESS

OTHER

Please select one applicable Brand

Butech

Haskel

Hartell

Internal (Burbank)

N/A

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