Skip to main content

Gasoline Complaint Form

Please note your Name and Telephone number are confidential.

Please indicate type of complaint: (Required)



Grade/Octane of fuel purchased:

Do you have a receipt:

Did you pay by credit card or cash:

Does the receipt price match the price on the pump:

Were you charged the amount shown on the pump:

Did you speak to the clerk at the gas station:

Maximum number of characters: 2,000

Retype the characters from the picture in the space provided: (Required)
Retype the CAPTCHA code from the image
Change the CAPTCHA codeSpeak the CAPTCHA code