| Supplier Name | |
|---|---|
| Supplier Code | |
| ECN Number | |
| Date Issued | |
| Contact Person | |
| Email / Phone |
| Part Number(s) Affected | |
|---|---|
| Current Revision | |
| Proposed Change |
| Reason for Change | |
|---|---|
| Benefits | |
| Risk Assessment |
| Planned Implementation Date | |
|---|---|
| First Affected Delivery Date | |
| Disposition of Old Inventory | |
| Special Instructions |
| Supplier Authorized Signature | |
|---|---|
| Date | |
| Customer Review/Approval | |
| Date |