WIC Vendor Complaint Form

Only applicable if a Vendor
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.

Have you ever filed a complaint against this Vendor?

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:

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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