Mott Community College
Purchasing Department
VENDOR COMPLAINT FORM
YOUR NAME: _____________________________ YOUR DEPARTMENT: _______________________________
EMAIL ADDRESS: ______________________________ PHONE NO.: ___________________________________
DATE COMPLAINT SUBMITTED: _________________________ P.O. or BPO # : _________________________
VENDOR:_________________________________ VENDOR CONTACT:________________________________
1. LATE DELIVERY 10. SHIPMENT SENT COLLECT
2. UNAUTHORIZED SUBSTITUTION 11. REQUEST TO CANCEL (describe below)
3. POOR QUALITY 12. OVERSHIPMENT
4. POOR WORKMANSHIP 13. FAILURE TO RESPOND TO CALL OR LETTER
5. POOR SERVICE 14. FAILED TO RESPOND TO SERVICE REQUEST
6. DOUBLE BILLING 15. SHIPPED USED GOODS
7. INCORRECT INVOICES 16. RMA (Return Authorization Request)
8. FAILED TO MEET SPECIFICATIONS 17. ITEMS MISSING IN SHIPMENT
9. UNMARKED/UNIDENTIFIED SHIPMENTS 18. OTHER (describe below)
Has this complaint been resolved by end user or department? Yes No
Would you like to be contacted regarding this complaint? Yes No
Complainant’s Signature: ______________________________ Title:___________________________________
Phone #:_________________________________________ Date: _____________________________________
Fax to the Purchasing dept at: 810-762-5645
Received by: _____________________________________ Date:______________________________________
Buyers Action:
Buyers Signature: __________________________________ Date:_____________________________________
Scan and save to: K:\14_Vendor Performance
DETAILS OF COMPLAINT (attach additional pages if needed)
Issue Date: 01/03/2012 Revision (0)
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