Consumer Affairs
Weights & Measures Program Consumer Complaint Form
Please provide the following contact information: First name Last name Work Phone Home Phone E-mail Enter the Name of the Store: Enter the Location of the Store: Enter the Date of Incident: Enter the Time of Incident: Describe the Incident: Do you Have the Receipt? Yes No
Please provide the following contact information:
First name
Last name
Work Phone
Home Phone
E-mail
Enter the Name of the Store:
Enter the Location of the Store:
Enter the Date of Incident:
Enter the Time of Incident:
Describe the Incident:
Do you Have the Receipt?
Yes No
Weight & Measure Centennial
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Complaint Form
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