Complaint Against WIC Store

Contact Information

Name*

WIC staff need your information for following up, but you will remain anonymous.

First Last

Phone Number*

Email Address*

State all facts, including date and time of incident, name and location of store, name(s) of other(s) involved and witnesses, if any.

Date and Time of Incident*

Store Name and Number*

Please include either the store number, address, and/or nearest cross-street to help identify chain stores.

List the Name(s) of Staff Involved

If you don't have their name, a physical description can be helpful.

Describe the Incident*

Please provide as much detail as possible so that we can effectively follow up.

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Phone

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