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Weights and Measures Complaint Form
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Weights & Measures
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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
No
Do you have the package?
Yes
No
What is the UPC number?
What should it scan at?
What were you charged?
Did you contact any person at that location?
Yes
No
What is their name(s)
or describe them
Leave this field blank