Participant Vendor Dissatisfaction Form

Please use this form if a vendor is consistently at fault for any of the following and/or you would like to inform us of any dissatisfaction you experienced with a vendor. Please be assured the information you submit to us is confidential. We will notify you at an appropriate time when action is to be taken.

Questions in red are mandatory.


Your Information
Full Name:
District/Agency Name:
Phone Number:
E-mail Address:
Vendor Information

Vendor Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State:
Zip:
P.O. Number:
P.O. Date: ex: mm/dd/yyyy
Details of Complication/Incident 

Bid: 

BOCES Bid (Quote) Number :

List Item Number:                      

Nature of Dissatisfaction:










Description of Item(s):

District/Agency Comments:
Please be accurate, complete and factual, and in addition, indicate the manner in which you suggest your complaint be settled.
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