Weights & Measures Complaint Submission

Mississippi Department of Agriculture & Commerce

Complainant Information

Anonymous Submission#field(17171)
Name#field(17142) #field(17143)
Phone#field(17144)
Email#field(17145)
Date Occurred#field(17146)

Business Information

Business Name#field(17149)
Address#field(17150)
#field(17151)
#field(17152), #field(17153) #field(17154)

Details of Complaint

Product Weighed#field(17157)
Total Weight#field(17158)
Weight Deduction#field(17159)
Printed Weigh Ticket?#field(17160)
Remote Display?#field(17161)
Saw Actual Weight?#field(17162)
Asked for Reweigh?#field(17163)
Weight in Question Was#field(17164)
Customer Was#field(17165)

Details of Complaint

#field(17166)

Acknowledgment

#field(17167)
Submission ID: #submit_id