Exemption certification per section 3(6)(B) of the Fastener Quality Act P.L. 106-34,
'Fastener Quality Act Amendments Act of 1999'.
date: ___/___/______
This certifies that goods purchased from:
(suppliers company name) __________________________________________
by: (purchasers signature or name) ___________________________________
of: (purchasers company name) _____________________________________
on purchase order number:__________________________________________
dated: ___/___/______ are for use as either a spare, substitute, service, or replacement
part per section 3(6)(B) of the Fastener Quality Act P.L. 106-34, 'Fastener Quality
Act Amendments Act of 1999'. I further acknowledge that these parts will be packaged in
containers of 75 pieces or less.
mina form fqa2 ver 11/22/99a
If you are going to use the 75 piece exemption rule then,
it is probably a good idea to have a copy of the form, completed by the
customer, in your
customer records to show that you have complied with that provision of
FQA99. You may revise the above form to suit your particular organization.
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