WIC Vendor Complaint Form

(Only applicable if a Vendor)
(First)
(Last)
(Please enter the phone number in XXX-XXX-XXXX format)

In the box below, please provide a description of the complaint against the WIC Vendor or Grocer. Be sure to include the important details such as names of persons suspected and dates if available.

(Time Format Example: 2:00 pm)

You are able to file a WIC Vendor Complaint anonymously, but if you would like the WIC State Agency to contact you, please complete the fields below: