Guidelines for Completing Vendor Complaint Form

Vendor Complaint Form

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University of Medicine and Dentistry of NewJersey VENDOR COMPLAINT REPORT		DO NOT WRITE IN THE BLOCK, FOR PURCHASING ONLY
UMDNJ Purchasing Liberty Plaza 335 George Street New Brunswick, NJ 08901	Vendor ID No.	Commodity Code.	Complaint No.
	Status: _ OPEN _CLOSED	Other: _ SPECIFICATION _VENDOR _CANCELLATION_DEBARMENT _SUSPENSION
	Purchasing Department	Fiscal Year	Date Received
INSTRUCTIONS TO DEPARTMENT. Please type or print. Complete Sections 1 to 5 below, Retain Gold Copy for your records.Submit White, Canary and Pink Copies to the Purchasing Department, noted above. DO NOT FORWARD COMPLETED FORM TO VENDOR.
1.NAME AND ADDRESS OF DEPARTMENT		2.NAME AND ADDRESS OF VENDOR
PERSON TO CONTACT	TELEPHONE NUMBER	PERSON TO CONTACT	TELEPHONE NUMBER
3. Purchase Authorization (Check One): Purchase Order No_____________________________________________ Requisition No____________________________________ Other____________________________________________ Enter Total Cost of Commodity or Service: $___________________________		4. CHECK NATURE OF COMPLAINT (S) _ Not Delivered (or) _Late Delivery _ Product or Service Not Meeting Specifications _ Unsatisfactory Service or Performance of Product _ Incorrect Price _Other______________________________________
5. DETAILED REPORT (Givedetailed explanation and attach additional sheets If necessary, Please print and type) _ Check here if continued on separate sheets.
SUBMITTED BY (Print or Type)	NAME	TITLE	DATE
VENDOR'S REPORT
INSTRUCTIONS TO VENDOR: Please print or type. Response to Purchasing Department should include corrective action to be initiated. Attach additional sheets if necessary. Retain Pink Copy for you records and return Canary to Purchasing Department, at the address noted above.
SUBMITTED BY (Print or Type)	NAME	TITLE	DATE

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