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Department of Procurement Services Vendor Complaint Form
Form # 12-0222 Page 1 of 1 Revised 8/2016
Vendor Information Name of Vendor: Vendor Contact Name:
Street Address: Title:
City: State: Zip Code: Phone #:
ODU Department Information Department Representative: Department:
Street Address:
City: State: Zip Code: Phone #:
Complaint Date: Contract #: P.O. #: P.O. Date Description:
Nature of Complaint: Please Describe Invoice/Payment:
Delivery:
Specifications:
Other:
Please send completed form to procurement@odu.edu
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