Weights and Measures Consumer Complaint Form
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Weights and Measures Consumer Complaint Form
Weights and Measures Complaint Form
Maryland Department of Agriculture
50 Harry S. Truman Parkway
Annapolis, MD 21401
Phone: 410-841-5790
Fax: 410-841-2765
Email:
[email protected]
1.
Date Received:
*
Please Choose Date:(MM/DD/YYYY)
2.
Your Name:
3.
Address:
4.
Phone:
5.
Alternate Phone:
6.
Email:
7.
Would you like to be notified with the results of our investigation?
Yes
No
8.
Date of Incident:
*
Please Choose Date:
Name of location of incident:
9.
Business Name:
10.
Business Address:
11.
Type of Complaint:
Gas Pump
Scale
Scanner
Short Weight
Advertising
Firewood
Miscellaneous
12.
Pump Number:
13.
Gas Grade:
Note: Pump number and gas grade required with pump complaint.
14.
Nature of Complaint:
SUBMIT My Complaint