Weights and Measures Complaint Form
Thank you for taking the time to complete this online form. Be sure to complete all of the information, which will help us to investigate your concerns.

Name of Complainant:

Complainant's Email:
Please send me a copy of the results.

Phone Number:     Date of Complaint:

Firm's Name:     Address:

(Examples: fuel pump, scale, scanner, package commodity)

Location of Device:
(Examples: pump 3, premium gas, 87 octane, scale in aisle 7, back counter)

Reason For Investigation:

Characters remaining: