Supplier Change Form

Supplier Request for Change (SRFC)

* Indicates a required field.

Section 1 — To be Completed by Supplier
Supplier:*	Email:*
Supplier Contact:*
Address:*
City:*	State:*	Zip:
Tel.:*	Fax:
Date of Request:*

Part Number:
Part Description:		Tool Asset #s / Cavity #s, if apply
Horton Location Product is Shipped To:	Britton, SD Carmel, IN Schweinfurt, Germany Other
Supplier Attachment:	Drawing Data Samples Other Upload File

Change Type

Check all that Apply:

Change in Production Process or Method
Change in Material
Supplier or Sub-tier Supplier Change
Change in Test or Inspection Method
Manufacturing Product that has been Inactive for >1 Year
Manufacturing Location Change
Correction of Discrepancy
Other (Specify)

Description of Change:

Reason for Change:

Identify Impact of the Proposed Change:

Product Impact:	Form / Fit / Function / Reliabilty	PPAP	Packaging
	Part Cost: From $ To $	Inventory	Other (Specify)
	Special Characteristic or Critical Characteristic	None	Other (Specify)

Current Specification:
(if applicable)

Proposed Specification:
(if applicable)

Qualification Plan with Target Date (e.g. PPAP Submittal):

Proposed Change
Effectivity Date:

Note: Change approval may take an extended period of time when Horton customer approval is required.
Changes shall not be permitted prior to the receipt of written approval from Horton.