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 CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.