Maine Women, Infants and Children Nutrition Program (Maine WIC) - Division of Family Health

DHHS → MECDC → Disease Prevention → WIC → For Vendors → Vendor Participant Feedback

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Store name
WIC vendor number
Address
City, state, zip code
Store phone
*E-mail address
Store Manager/WIC Contact
Food:	Wrong size/amount Wrong food brand Type of food
Food instrument (check)	Used another person's check without authorization Used an altered check Used a check before or after valid dates Pre-signed a check
Transactions	Signature did not match WIC authorization folder Did not have WIC authorization folder Attempted to claim cash back from purchase Attempted to trade WIC food for other food, cash or credit Did not separate WIC food from other food
Participant	Was the alternate buyer Needs more training on WIC foods Was rude and/or argued Was cooperative when given an explanation of WIC program rules
Details of incident
Name of person filing this report

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