Metric Importers of
North America (MINA)
FQA 280.11 Significant Alterations of Fasteners form
MINA designed; NIST approved format for section 280.11 (a)(3) notification to purchaser of significant alterations.
280.11 Significant Alterations of Fasteners.
ref 280.11 (a)(3)
"unless the significantly altered fastener is delivered to a purchaser accompanied by a written statement noting the original lot number and the new lot number assigned by the alteror, disclosing the subsequent alteration, and warning that such alteration may affect the dimensional or physical characteristics of the fastener."
Just change the data as appropriate for your company.
------------- MINA designed sample form below -----------------
Supplying Company Name
Supplying Company Address
certifies that the fastener requested by:
Purchasing Company Name
Purchasing Company Address
On Date: ______________________________________________
Purchase order number: _______________________________________________________
Purchase Order Line number or description: _______________________________________________________
Parts from Lot number: _______________________________________________________
Was/were manufactured, modified, altered or significantly altered to your specifications.
Pursuant to the Fastener Quality Act, section 280.11 (a)(3) Significant Alterations of Fasteners,
You are hereby given warning that such alteration may affect the dimensional or physical characteristics of the fastener.
filename: fqamodform.doc
------------- end .. MINA designed sample form -----------------
This example form contains the minimum of information required by the FQA.
You may also add additional information.
MINA grants freedom to copy priviledges on this form.
Be advised that any communications from MINA should not be taken as
legal advice.
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