Complaint Form | Somerset County

Please correct the field(s) marked in red below:

*By providing your your contact information, you agree to receive communication from this office.

Complaint Reported By:

Complaint Reported By:

Full Name

Email*

Home/Cell Phone*ext.

Work Phone*ext.

Address

City

State

Zip Code

Complaint Reported Against:

Complaint Reported Against:

Name

Business

Address

City

State

Zip Code

Phone (1)ext.

Phone (2)ext.

Nature of complaint (please check all that apply):

Employees involved in your complaint:

Please list names and titles of company agents or employees involved in your complaint:

Losses:

Losses:

The amount of loss involved in this complaint:

Please provide a breakdown of these losses:

Describe the facts of your complaint in the order in which they happened:

Describe the facts of your complaint in the order in which they happened:

I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. I authorize the Somerset County Office of Weights and Measures to release this complaint form upon request by interested parties and to use the information in any way that is necessary.

This certification must be signed by the person completing the form.

Full Name

Date

I understand by typing my name, I am electronically signing this document.

Please email WeightsAndMeasures@co.somerset.nj.us with any readable copies of any complaint-related contracts, bills, receipts, canceled checks, correspondence or any other documents you feel are related to your complaint.

To receive a copy of your submission, please fill out your email address below and submit.
Email Address

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