Metric Importers of North America (MINA)
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Manufacturer: |
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Address: |
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Customer: |
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Address: |
| Product Description: | Purchase Order Number: |
| Product Standard: |
Date of Manufacture: |
| Nominal Dimensions: |
Finish: |
| Material Grade and Standard: | Head Marking: |
| Mfg. Lot No.: |
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This lot or portion is accompanied by a laboratory test report with a serial number of:
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Date of Issue: |
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Mfg.'s Authorized Signature: |
Title: |
Date:
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Mfg.'s Authorized Signature: |
Title: |
Date:
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The importer hereby assumes responsibility for the inspection and testing of the above listed lot or portion to be conducted by a laboratory accredited in accordance with the Fastener Quality Act.
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Importing Company Signature: |
Title: |
Date: |
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