Store Feedback

WIC is committed to providing you a pleasant shopping experience. We welcome your comments, suggestions, and issues involving a WIC approved store so please leave them for us. If you would like us to contact you in regards to your inquiry please be sure to include your name and e-mail.

Participant Information: (optional)

WIC Participant Name:
WIC Participant ID:
WIC check number:
E-mail:

Store Information

Store type:	-Select- Supermarket Grocery (medium/small) Convenience Store
Store name:(required)
Location: (required)
Date of occurrence:
Time:
Lane:
Cashier name or ID no, (On receipt):
Name or description of store employee(s) involved:
Check all that apply:	Store failed to stock minimum amounts of WIC foods accepted WIC check before or after valid dates. Store did not obtain a signature for a WIC transaction Store sold or tried to sell out-of-date WIC foods Store allowed WIC check to be used for unauthorized foods or excess amounts of food Store failed to provide itemized receipt for foods failed to request WIC ID folder from participant Store required participant to purchase all foods listed on WIC check Store required participant to purchase a single brand of WIC food when multiple authorized brands were available Store demanded participant's signature before filling in purchase prices Store failed to provide same promotional specials to WIC participants as to non-participants Store required WIC participants to use specified checkout lanes. Store required extra cash purchases to redeem WIC drafts Store intentionally defrauded or attempted to defraud WIC program Store allowed purchase of non-food items with WIC check. Store traded cash or credit for WIC checks. Store charged more than shelf price for WIC foods Store charged for food not purchased but listed on check Store failed to provide same courtesy to WIC customers as to non-WIC customers
Details of occurrence:

Name of person filing this report:

We appreciate your support in letting us know about your WIC shopping experience. Our WIC vendor unit will inform the WIC authorized store. If needed we provide more education to WIC program rules, and will follow up to be sure the matter is addressed. Thank you for your help!

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