Weights and Measures Complaint Form

Contact Information

Please enter your first and last name
Please enter your address
( ) -
Please enter your phone number
Please enter your email

Business Information

Please enter as much information about the business as possible.

Today
Pump Number, Isle Number, Register/Check out Number, etc.
Did you retain a Receipt, Bill or Statement?*:

Describe the nature of your complaint. Write down the events leading to it in the order in which they happened. Please include specific dates, times, individuals you dealt with and the product description.