WIC Concern Questionnaire
Please fill out and submit the following questionnaire to help us gather more information about the problem you experienced during your WIC shopping experience.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Shopping Experience
*
-
Month
-
Day
Year
Date
Location and Name of Store (i.e. Whitefish Super One)
*
Please select what category your concern fits in to:
*
UPC Issue
Item Out of Stock
Issue with eWIC Card
Untrained store staff
Incorrect label or shelf mislabeled
Other
Please describe your concern.
Please select the category of food you experienced the problem with:
Fruit
Vegetable
Dairy
Grain
Formula
Baby food
Protein
Please select the category that best describes the eWIC card issue:
Purchase denied
Invalid PIN
System error
Please provide more information regarding the eWIC card issue you experienced:
Please select the category that best describes the UPC issue:
Item in app but not ringing up at register
Item ringing up at register but not listed in app
Item not in app nor ringing up at register
Issue at self check out
Please upload a picture of the UPC and front of the item, including the brand label.
Browse Files
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Choose a file
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of
Please list the item that is desired but is not available:
Please select the category that best describes the staff training issue:
Staff did not know how to use eWIC card
Staff did not know how to provide a refund
Staff did not know how to troubleshoot an issue
Please provide more information regarding the staff training issue you experienced:
Please provide more information regarding what item or shelf was mislabeled.
Has this concern been reported elsewhere?
Yes
No
Where else did you submit this concern?
Submit
Should be Empty: