Weights and Measures Complaint Form

*Weights & Measures does not accept anonymous complaints*

First Name

Last Name

Phone

Alternative Phone

E-mail

Name of Business

Address of Business

Date of Incident

Time of Incident

Device Type

(scale, gas pump, etc)

Device Identification

(gas pump number, etc)

Describe the Incident

Do you have the Receipt?

Yes

Do you have the package?

Yes

What is the UPC number?

What should it scan at?

What were you charged?

Did you contact any person at that location?

Yes

What is their name(s)

or describe them