Montgomery County
Weights & Measures
Consumer Complaint Form

*First Name:
*Last Name:
Address:
City:
State:
Zip:
Phone:
*Email Address:
I have a complaint against:
*Business Name:
Date & Time:
*Address:
City:
State:
Zip:
Type of Complaint:	If Other, please specify:
Type of Fuel:	Octane:
*Would you like to remain confidential when we contact the business?	Yes No
*Describe your complaint:

I understand under PL 210.45, that making a false written statement is a Class A Misdemeanor, punishable by up to a year in jail.

Montgomery CountyWeights & MeasuresConsumer Complaint Form