DOCUMENT #: TJ-VF-2012-0801 REV: 0 DATE APPROVED: 02/06/2013

TITLE: EXPEDITE REQUEST FORM

VERTICAL FORM STATUS: ISSUED Page: 1 of 2

Expedite Request Form

Requested By: Lissette Norberto Date Submitted: 7/27/2022
Supplier Name: Several Original Delivery Date: 7/29/2022
Customer Ortho Clinical Diagnostics Date Needed by: 7/28/2022
Program:
Pickup Location RL Jones
Address:

Expedite Information
Part# *Reason for Total Cost ($) To be Part PO#: Quantity Parts
expedite: and (Variance charged to? (packing) needed
from original before original
price(-/+)) delivery date

Material Shortage $450.00 OCD 60 pcs

CD994833 4508781391

Material Shortage OCD 10 pcs

CDJ57333 4509083305

Material Shortage OCD 10 pcs

CDJ57333 4509083305

Material Shortage OCD 10 pcs

CDJ57333 4509083305

*Please note that “Line Down” is not an acceptable reason. Please use one of the following:
1. Supplier Fail 2. Customer Forecast Change 3. Force Majeur 4. Freight Supplier Fail 5. Customer Request 6. Other _____ (please fill in)

Digitally signed by
Signature Lissette Norberto Date
Date: 2022.07.27
16:59:23 -04'00'
Digitally signed by Daniel Valencia
Signature
Daniel Valencia Reason: I am approving this document
Date: 2022.07.28 09:00:59 -07'00'
Date

Signature Date

Approval of this document is electronic

 DOCUMENT #: TJ-VF-2012-0801 REV: 0 DATE APPROVED: 02/06/2013

TITLE: EXPEDITE REQUEST FORM

VERTICAL FORM STATUS: ISSUED Page: 2 of 2

Signature Date

Signature Date

Comments:

Document Distribution: Belem Estrada/NPA - Tijuana

(Hard Copy)

Change Information:

Approval of this document is electronic