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PART SUBMISSION WARRANT
Delivered Part
Part Specifications
PART MANUFACTURING INFORMATION
Part Name
Part Number
Safety and/or Government Regulation
YES NODrawing Change Level
Additional Changes
Drawing Number Engineering Change#
SUPPLIER MANUFACTURING INFORMATION
Supplier Name Supplier Code
Address
City State Zip Code
SUBMISSION INFORMATION
Dimensional Material/Functional Appearance
Customer Buyer
REASON FOR SUBMISSION
Please Select Reason:
REQUESTED SUBMISSION LEVEL (Check one)
Submission Level:
SUBMISSION RESULTS
Dimensional measurements Material and functional tests
Appearance Criteria Statistical Process Package
These results meet all drawing and specification requirements:
YES NO
Declaration
I hereby affirm that the samples represented by this warrant are representative of our parts, have been made to the applicable Production Approval Process Manual 3rd Edition. I have noted any deviations from this declaration below.
Requirements: I further warrant these samples were produced at the production rate of:
/8 hours
EXPLANATION / COMMENTS (may not demonstrate the production Run-at- Rate capacity)
Print Name
Title
Phone Number
Fax Number
DateSupplier Authorized Signature
FOR CUSTOMER USE ONLY
Part warrant disposition: Approved Rejected
Part Functional Approval: Approved Rejected
Customer Name
DateCustomer Signature
Specified Measured
A: Width = 15.83 +/- 0.03 in
B: Axle Bore Dia = 3.94 +/- 0.01 in
C: Driveshaft Bore Dia = 3.93 +/- 0.01 in
D:
E:
F:
G:
H:
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