Complaint Form - Erie County businesses only

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*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

Do you have the package?:

Yes

What is the UPC number?:

What should it scan at?:

What were you charged?: *

Did you contact any person at that location?: *

Yes

What is their name(s):

or describe them: