Response

In order for the Texas Department of Agriculture to pursue an investigation of a complaint please provide all information related to your complaint, including a complete explanation of your complaint.

Incident Details:

Date of incident:

Approximate time of incident:

AM/PM:

Feedback or information to
offer, including name of TDA
employee, if applicable:

Incident Business Name:

CEID

Street:

City:

County:

Zip:

State:

Vehicle license plate:

Vehicle make and model:

Vehicle color:

Your Details:

Do you wish to
remain anonymous?

Yes

Preferred
contact method:

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Phone