Weights & Measures Complaint Submission

#field(4445)

Complainant Information

Anonymous?#field(4437)
Name#field(4438) #field(4439)
Phone#field(4440)
Email#field(4441)
Date Occurred#field(4442)

Business Information

#if(#field(4451)) #endif
Business Name#field(4445)
Address#field(4446)
#field(4447)
#field(4448), #field(4449) #field(4450)
Other#field(4451)

Nature of Complaint

Product Weighed#field(4456)
Total Weight#field(4457)
Weight Deduction#field(4458)
Printed Weigh Ticket?#field(4459)
Remote Display?#field(4460)
Saw Actual Weight?#field(4461)
Asked for Reweigh?#field(4462)
Weight in Question Was#field(4463)
Customer Was#field(4464)

Details of Complaint

#field(4452)

Acknowledgment

#field(4454)
Submission ID: #submit_id