For San Mateo County residents only. * Required Fields Product Information Date of Purchase Product Brand Size Posted Price? Price Charged? Receipt Scan One file only.2 GB limit.Allowed types: gif, jpg, jpeg, png. Comments: Product Information Contact Information Your Name Title Title - None -MissMsMrMrsDrOther… Enter other… First Middle Last Suffix This information is confidential, but needed in order to ensure timely response to the complaint. Address Address City/Town Phone Email Address Store Information Store Name Store Address Address City/Town Near Cross Streets Comments: Store Information How did you find out about our consumer complaint forms? How did you find out about our consumer complaint forms? - None -Online Search Engine (e.g. Google)Community EventFriend, acquaintance, or coworkerBrochure/Flyer“Attention Consumers” Yellow StickerOther… Enter other… Leave this field blank