PRIME QUALITY - WORK ORDER

Date*

MonthDayYear
Date
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Representative Name

First NameLast Name
Title
Email Address
A copy of this document will be forwarded to the recipient
Phone Number
Format: (000) 000-0000.
Preferred Method of Communication (Can choose multiple)

Phone CallEmailTextOther
Is there an alternate contact in their organization?

YesNo
Alternative Representative Name

First NameLast Name
Title
Email Address
A copy of this document will be forwarded to the recipient
Phone Number
Format: (000) 000-0000.
Sort Start Timeframe (Can choose multiple if Supplier is flexible)

ImmediateNext ShiftNext DayOther
Part Description
Estimated Weight of Part

Under 5lb5lb - 10lbOver 10lb
Brief Description of defect and location
Consumable for mandatory witness mark (as directed by Host facility)
PPE Included:

Safety Glasses | Hearing Protection | Steel Toe Shoes | Safety Vest
Additional PPE or Consumables Required?

YesNo
Detail Additional PPE or Consumables
Do you agree to reimburse Prime Quality for additional PPE or Consumables?

YesNo
Are there special gauges required?

YesNoUnsure
Specify speciality gauge or add further information.
Will you be sending the Work Instruction?

YesWe will develop and forward for approval
Host Location
Detail Location including address and entrance details
Site Location Representative / Contact

First NameLast Name
Title (if known)
Site Location Email
example@example.com
Phone Number
Format: (000) 000-0000.
Estimated Minimum Resource Requirements

** Advise Supplier that we will confirm requirements after a time study and on-site quantity verification **
Estimated Number of Inspectors Required?
Team Leaders Required? (Minimum 1)
Host or Supplier Rates

Default HostDefault SupplierPreferred Host - Negotiated QuotePreferred Supplier - Negotiated QuoteOther
Rates for billing

Host Rate - Inspector @ $33phPreferred Host Rate - Inspector @Project Support Fee 3%Team Leader @ $39phTeam LeaderTeam Leader @ $39ph$35phOther
Rate for billing
Project Support Fee

3%5%Other
Can we start without a Purchase Order?

YesNo
Billing Information (Request Details / contacts ie. Names, emails, extension numbers etc.)
Should be Empty: