FORM PC-104 (10-92) - NC
|STATE OF NORTH CAROLINA |[pic] | |
|DEPARTMENT OF INFORMATION TECHNOLOGY | |IT PROCUREMENT COMPLAINT TO VENDOR FORM |
|STATEWIDE IT PROCUREMENT OFFICE | | |
|PO Box 17209 | |Date: |
|RALEIGH, NC 27619-7209 | | |
|FROM |SUBJECT |
| | |
|(Agency) |Purchase Order No.: Dated: |
| |(Attach copy) |
|(Address) |For Commodity No.: |
| | |
|(City, State and Zip Code) |Commodity: |
| | |
|(By) (Title) |TERM CONTRACT NO.: |
|Phone No.: | |
| |BID/QUOTE NO.: |
|TO (Vendor) | |
| | |
|(Name) |TO VENDOR - PLEASE NOTE AND COMPLY |
| | |
|(Address) |Reply to the agency and to the Statewide IT Procurement Office within 15 calendar|
| |days. Failure to reply may result in your company being deleted from our |
|(City, State and Zip Code) |prospective bidder’s mailing lists; and/or your future proposals not being |
|Phone No.: |considered or removal from a contract. |
FOR ACTION VENDOR RECORD ONLY
MAKE THE COMPLAINT SPECIFIC AND PROVIDE DETAILS
We have the following complaint:
................
................
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