"Consumer Equitability Consumer Complaint Form" - Nevada

Consumer Equitability Consumer Complaint Form is a legal document that was released by the Nevada Department of Agriculture - a government authority operating within Nevada.

Form Details:

  • The latest edition currently provided by the Nevada Department of Agriculture;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download "Consumer Equitability Consumer Complaint Form" - Nevada

Download PDF

Fill PDF online

Rate (4.5 / 5) 6 votes
Page background image
Consumer Equitability
Consumer Complaint Form
INVESTIGATION # ……………………………………… 
 
       
DATE: ………………… TIME: …………………… 
COMPLAINT REC’D BY: ………………………………… 
INVESTIGATOR/INSPECTOR: ……………………………………  
Phone  Voicemail  Email    Online    Walk-In Other ……………………………..
COMPLAINANT’S NAME: …………………………………………….………………….     Requests Investigation Results  
PHONE #: …………………………………………………………….   EMAIL: …………………………………………………………………… 
 
BUSINESS NAME: …………………………………………………………………………………………………….. AREA #: ………….
ADDRESS/CROSSROADS: …………………………………………………………………………………………………………………….
CITY: …………………………………………………… ZIP: …………………………………… COUNTY………………………………….
PHONE # (if available): …………………………………………………………………………………………………………………………
DATE OF OCCURRENCE: …………………………………….
TIME OF OCCURENCE: …………………………………….
TYPE OF COMPLAINT:  Fuel Station Pump #: …………… Grade: ……………
Petroleum Contamination 
Scale  
Price Verification/Scanning   
Packaging 
Other ……………………. 
 
COMPLAINT DESCRIPTION:
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
INVESTIGATOR/INSPECTOR USE ONLY:
INVESTIGATOR/INSPECTOR NAME: ________________________________________________________________
DATE OF INVESTIGATION: ____________ TIME OF INVESTIGATION: _______________ TOTAL TIME: ___________
 
INVESTIGATION REPORT: _________________________________________________________________________
 
______________________________________________________________________________________________
 
______________________________________________________________________________________________
 Valid  
 Invalid 
 Undetermined 
 
INVESTIGATION STATUS:
DID INVESTIGATOR/INSPECTOR CONTACT COMPLAINTANT FOR RESULTS?
 
 Yes Date: ________ Time: ___________ 
 No
 
INVESTIGATOR/INSPECTOR SIGNATURE: ___________________________________________________
page | 1
Consumer Equitability
Consumer Complaint Form
INVESTIGATION # ……………………………………… 
 
       
DATE: ………………… TIME: …………………… 
COMPLAINT REC’D BY: ………………………………… 
INVESTIGATOR/INSPECTOR: ……………………………………  
Phone  Voicemail  Email    Online    Walk-In Other ……………………………..
COMPLAINANT’S NAME: …………………………………………….………………….     Requests Investigation Results  
PHONE #: …………………………………………………………….   EMAIL: …………………………………………………………………… 
 
BUSINESS NAME: …………………………………………………………………………………………………….. AREA #: ………….
ADDRESS/CROSSROADS: …………………………………………………………………………………………………………………….
CITY: …………………………………………………… ZIP: …………………………………… COUNTY………………………………….
PHONE # (if available): …………………………………………………………………………………………………………………………
DATE OF OCCURRENCE: …………………………………….
TIME OF OCCURENCE: …………………………………….
TYPE OF COMPLAINT:  Fuel Station Pump #: …………… Grade: ……………
Petroleum Contamination 
Scale  
Price Verification/Scanning   
Packaging 
Other ……………………. 
 
COMPLAINT DESCRIPTION:
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
INVESTIGATOR/INSPECTOR USE ONLY:
INVESTIGATOR/INSPECTOR NAME: ________________________________________________________________
DATE OF INVESTIGATION: ____________ TIME OF INVESTIGATION: _______________ TOTAL TIME: ___________
 
INVESTIGATION REPORT: _________________________________________________________________________
 
______________________________________________________________________________________________
 
______________________________________________________________________________________________
 Valid  
 Invalid 
 Undetermined 
 
INVESTIGATION STATUS:
DID INVESTIGATOR/INSPECTOR CONTACT COMPLAINTANT FOR RESULTS?
 
 Yes Date: ________ Time: ___________ 
 No
 
INVESTIGATOR/INSPECTOR SIGNATURE: ___________________________________________________
page | 1