Report of Unsatisfactory by armedman1


									                                               Report of Unsatisfactory
                                               Materials and/or Service

Purchase Order No.:                                    Contract No.:
Supplier Name:                                         User Department:
Address:                                               Prepared by:                          Ext.:
City, State, Zip:                                      Date:
Telephone No.:                                         Budget Head Signature:

Statement of Problem: (Specifics of Unsatisfactory Materials or Service)

                                                                            Attach supporting documentation

Use reverse side or attachments if necessary

         Supplier's Response to Complaint

To Above Referenced Supplier: The above complaint has been submitted by a PCC department. In
the space below (or via attachment), kindly respond in writing within 10 days. Include what will be
done to correct this specific complaint, and what safeguards will be made to assure future problems
of this type do not occur. Failure to respond could result in withholding payment on your invoice or
could be cause for disqualification from future bidding with PCC.


Use reverse side or attachments if necessary

Supplier Representative:
Printed Name:                                          Date:
Title:                                                 Telephone No:

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