Agility Fuel Systems
1815 E. Carnegie Avenue, Santa Ana CA 92705 Phone (949) 236-5520
Please fill in electronically all responses and send to your buyer. / 1 Agility Vendor Number
2Supplier Name: / 3 Date Created:
4aAddress: / Agility Use Only - Tracking No:
4bCity: / 4cState: / 4dZip code: / Agility Only - Permanent or Temp:
5 Phone No.: / 5 Email Address:
6 Agility Part No / Assembly No.: / 7 Rev. #: / 8 Part Name / Description: / 9 Agility Fuel Systems PO No.: / 10 PO Line:
11 Quantity of Non-conforming Pieces:
(List serial numbers, if applicable, on separate attached sheet) / 12 Batch or Lot # : / 13 Supplier Part Number (if applicable):
14 Description of Nonconformance (include Drawing zone location and other descriptions as necessary – attach sketch or photos or extra pages as required):
15 Description of Root Cause of the Nonconformance: (mandatory):
16 Description of Corrective Action: (Deviation must have an effective corrective action):
17 Corrective Action Effectivity Date or Lot / Serial No.:
18 Supplier Representative Title and Name (print & sign name):

Supplier Deviation Request Form

Supplier Deviation Request Instructions

The following information is required from the Supplier

Note: The deviation form is a fillable field form. All sections must be completed by supplier for consideration of request to be accepted.

  1. Vendor Number – The Supplier is to provide their assigned Agility Fuel Systems supplier number.
  2. Supplier Name.
  3. Date Created – (MM/DD/YYYY).
  4. Supplier Address (include City, State and Zip Code).
  5. Supplier Phone and eMail address.
  6. Agility Fuel Systems Part / Assembly Number.
  7. Revision Level.
  8. Part Name / Description.
  9. Agility Fuel Systems PO / Contract Number.
  10. PO Line No.
  11. Quantity Nonconforming (list serial numbers, if applicable, on separate attached sheet).
  12. Batch or Lot # (if applicable).
  13. Supplier Part Number (if applicable).
  14. Description of Nonconformance: (include Drawing zone location and other descriptions as necessary – attach sketch or photos or extra pages as required).
  15. Description of Root Cause (mandatory).
  16. Description of Corrective Action: Why the parts are nonconforming and what actions are to be taken to eliminate the nonconformances (i.e., Training, Drawing Change, Process Change, etc…) The Deviation Request Form must explain the supplier’s corrective action.
  17. Corrective Action effectivity date or Lot / Serial Number phase-in date.
  18. Supplier Representative printed title, name, and signature.

The following information is for Agility Fuel Systems use only

a)Tracking Number – Procurement may provide a tracking number. This is optional and has been superseded by the Quality Database NCR number.

b)MRB / Manufacturing Decision – Manufacturing Engineering shall approve or disapprove deviation into the Quality Database and provide comments regarding the supplier’s request.

c)MRB / Design Engineering Decision – Design Engineering shall approve or disapprove deviation into the Quality Database and provide comments regarding the supplier’s request.

d)MRB / Quality Engineering Decision – Quality Engineering shall input deviation into the Quality Database and approve or deny deviation and provide comments regarding the supplier’s request.

e)Purchasing Department – Agility Fuel Systems Purchasing is to complete the disposition portion of the nonconformance (NC) in the Quality Database and send the vendor a copy of the approved deviation and NC number or inform the supplier that the Deviation Request has been rejected.

f)NC Coordinator – The NC Coordinator shall assign the appropriate MRB personnel in the Quality Database and process the NC after completion.

Always include the Deviation Approval Number and corresponding NCR number on all shipping documents that accompany these parts to Agility Fuel Systems Form QAF-062 Rev 1