Restaurant Delivery Fee Complaint Form

First Name

Phone Number

Last Name

Email Address

Title

Retail Food Establishment Name

Doing Business As (DBA) if applicable

Street Address

City

State

Zip

Date of Violation

Name of Third-Party Food Delivery Service

Select the violation type:

Retail Food Establishment Consent

Delivery Charges

Delivery Wage Garnishment

Transparency Transaction

Telephone Charges

Please describe the violation:

Have you contacted the third-party service regarding this violation?

Yes

Include additional notes and comments (not required):

After submitting your information, a Community & Economic Development staff member will contact you to gather further documentation.

Department

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