Section 2: Scheduling (For Cal-Mold Inc. Production Control Use Only)

SAMPLE REQUEST

SECTION 1: CUSTOMER APPROVAL

ESTIMATED
CHARGE: / P.O. No.
AUTHORIZATON
SIGNATURE: / REQUEST DATE:
PLEASE
PRINT NAME: / PROMISE DATE:

PLEASE READ: The authorization signature or valid purchase order number above is an agreement to pay the ESTIMATED CHARGE amount above for the completion of work detailed below. Final billing amount is subject to change based upon actual work performed. Cal-Mold Inc. MUST receive either 1) a valid purchase order number or 2) authorizaton signature obligating your company with the responsibility to make payment for services rendered PRIOR TO BEGINNING ANY WORK per ISO 9002 standards. We thank you for your understanding and cooperation.

SECTION 2: SCHEDULING (FOR CAL-MOLD INC. PRODUCTION CONTROL USE ONLY)

MACHINE No.
SCHEDULED RUN DATE:

SECTION 3: CUSTOMER DATA

REQUESTED BY @ CMI (NAME): / SAMPLE No.:
CUSTOMER TELEPHONE: / CUSTOMER COMPANY:
CUSTOMER PRESENT (Y/N): / CUSTOMER CONTACT:
REASON FOR SAMPLE:
THIS FORM FILLED OUT BY:
NOTES:

SECTION 4: MOLD DATA

IS MOLD AT CMI (Y/N): / BASE DIM’S: / CAV’S: / 1
MOLD DUE DATE: / SAMPLED PRIOR (Y/N): / FAMILY?:
DATE RECEIVED: / MOLD No.:
NOTES:

SECTION 5: PART DATA

PART NAME: / EST. GRAMS: / ACTUAL:
PART No. / EST. RUNNER: / ACTUAL:
REV No.
COMPONENTS:
NOTES:

SECTION 6: MATERIAL AND COLOR DATA

RESIN SUPPLIER: / IS MAT’L AT CMI (Y/N):
RESIN TYPE: / MAT’L DUE DATE:
FILLER (Y/N or TYPE): / % LOAD: / DATE RECEIVED:
CMI MAT’L CODE: / CUST. SUPPLIED (Y/N):
DRYING REQUIRED: / DRYING TIME: / DRYING TEMP:
NOTES:
COLOR SUPPLIER: / % LOAD: / IS COLOR AT CMI (Y/N):
COLOR TYPE: / CUST. SUPPLIED (Y/N): / COLOR DUE DATE:
NOTES: / DATE RECEIVED:

SECTION 7: PRODUCTION & PACKAGING

PROCESS AUTOMATIC (Y/N): / EST. MACH SIZE: / ACTUAL:
EST. NO. OPERATORS: / ACTUAL:
EST. CYCLE (SEC.): / ACTUAL:
REQUIRED 2nd OPS:
SAMPLE INSTRUCTIONS:
NOTES:
QTY TO MAKE FOR SAMPLE: / ACTUAL PARTS MADE:
EST. BOX: / TBD / ACTUAL:
EST. PARTS / BOX: / ACTUAL:
ADDITIONAL PACKAGING:
NOTES:

SECTION 8: QUALITY ASSURANCE

100% 1st ARTICLE REQ’D (Y/N): / PRINTS REC’D (Y/N): / PRINTS DUE DATE:
CHECK CRITICALS ONLY (Y/N): / CRITICALS MARKED (Y/N): / No. OF PARTS TO BE MEASURED:
SPECIAL GAUGE(S) REQUIRED (Y/N): / GAUGE(S) TYPE:
PARTS APPROVED BY CMI QA (Y/N):
NOTES:

SECTION 9: SHIPPING DATA

DELIVER VIA: / ATTENTION:
NOTES:

SECTION 10: BILLING HOURS (FOR CAL-MOLD INC. USE ONLY)

TOOLROOM: / APPROVED: / NOTES:
SETUP: / APPROVED: / NOTES:
PLANT ENGINEERING: / APPROVED: / NOTES:
PRODUCTION: / APPROVED: / NOTES:
QUALITY: / APPROVED: / NOTES:
WAREHOUSE: / APPROVED: / NOTES:

SECTION 11: BILLING (FOR CAL-MOLD INC. USE ONLY)

ACTUAL CHARGE:
NOTES:

______

SECTION 12: (FOR CAL-MOLD INC. USE ONLY – PROJECT WORKSHEET)

Project: / Part Number: / Mold No.:
Meeting Date: / Next Meeting: / Team Leader: / WALT HORNE
No. / Action Item: / Responsible: /

Due On/By:

/ Status:
1
2
3
4
5
6
7
8
9
10

______

SECTION 13: (FOR CAL-MOLD INC. USE ONLY – MOLD ACCEPTANCE)

Mold Maker: / Molding Technician: / Shot Size:
Machine Tonnage: / Machine Number: / Mold No.
Items 1 – 14 to be filled in by the Molding Technician sampling the mold.
OK / Item: / Comments:
1. Opening and closing of mold.
2. Function of core pulls and slides.
3. Function of ejection system.
4. Function of cooling system.
5. Cavities fill evenly.
6. Able to pack out cavities.
7. Removal of runner system.
8. Removal of parts.
9. Function of shut offs.
10. Venting of cavities & cores.
11. Surface finish of cavities & cores.
12. Mold cycle successfully.
13. General
Comments:
14. Improvement Recommendations:

A P P R O V A L S:

ProductionSignature: / Print Name: / Date:
ToolroomSignature: / Print Name: / Date:
EngineeringSignature: / Print Name: / Date: