See FQA99 (P.L. 106-34) Section 4(a) for full text of the law.
Act Amendments Act of 1999'(FQA99).
date: ___/___/______
to: (purchasers company name) _____________________________________
reference your purchase order number:________________________________
dated: ___/___/______
(suppliers company name) __________________________________________
(suppliers signature or name) ________________________________________
certifies that the some/all of the goods listed on the purchase order
number above were:
___ electroplated after the initial manufacturing process from parts that
are covered by FQA99 and a new or amended "record of conformance"
is enclosed.
___ mechanically modified from existing parts that are covered by FQA99
and a new or amended "record of conformance" is enclosed.
___ mechanically modified from raw material to customer specifications
which render the part covered by FQA99 and the "record of conformance"
is enclosed.
___ other:____________________________________________________________
________________________________________________________________
________________________________________________________________
mina form fqa3 ver 12/05/99