Date of the Incident

Consumer Name

*Consumer Phone Number

In case we have questions about your complaint

Business Name

Business Address

Type of Business

Type of Complaint

Please tell us the product type and location in the store (register, deli counter, etc.).

Please tell us the product type and brand and if you have a receipt.

Do you have a copy or screenshot of the ad?

Details of Complaint

Do you want to know our findings?

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