Vendor Complaint Form - 112900

							                                                                         State of North Carolina
                                                                     Department of Administration
                                                                   Division of Purchase and Contract
                                                                        1305 Mail Service Center
              Complaint to Vendor Form
                                                                         Raleigh, NC 27699-1305
                        Date:



From                                                        Subject

Agency or Public School Unit:                               Purchase Order Number          Dated         (Attach Copy)

Address:                                                    Commodity Number:

City, State, and Zip Code:                                  Commodity:

By:                                                         Term Contract Number:

Title:                                                      Bid/Quote Number:

Phone Number:


To (Vendor)                                                 To Vendor – Please Note and Comply

Name:                                                       Reply to the agency and copy the Division of Purchase and
                                                            Contract. Failure to reply may result in your company being
Address:                                                    deleted from our vendor registration system and/or your
                                                            future proposals not being considered, or removal from a
City, State, and Zip Code:                                  contract.

Phone Number:


                                           For Action     Vendor Record Only

                                              Make Complaint Specific

We have the following complaint:




                       Copies To Vendor, The Division of Purchase and Contract, and Agency File
                                            Revised November 29, 2000