Supplier Request for MRB Action, Lear Romec

1. Your Information
First Name:*
Last Name:*
Title:*
Supplier Name:*
Date Requested:*
2. Lot Information
Part Number:*
Revision:*
Purchase Order No.:*
Lot Qty (Total):*

The following discrepancy has been noted by our Quality Control Department and will require your Material Review Board Action. Note: This form is to be submitted for each non-conformance.
3. Discrepancy Information
Specification/Requirement*
Condition/Defect*
Discrepant Quantity:*
Cause:*
Corrective Action:*
Cause Code (Ref. QCP-052, App. A):*	Defect Code (Ref. QCP-052, App. B):*	Process Code (Ref. QCP-052, App. D):*
Required for Sub-Out Orders	Required for All Orders	Required for Sub-Out Orders

Request for MRB Action (Lear Romec)