Find Dutchess County Government on Facebook  Get Tweets from Dutchess County Government  Web feeds from Dutchess County Government

<<< Go to Department of Behavioral & Community Health's Home Page

Dutchess County Division of Weights and Measures Gas Complaint Form

 

Please note your Name and Telephone number are confidential.

 
 
 
Please indicate type of complaint:





Date submitted:


Full name:


Email:


Telephone:


Name or brand of gas station:


Street address of gas station:


City/Town/Village where gas station is Located:     Zip code:


Date gas purchased:


Number of the gas pump:    OR Location of Gas Pump:


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: 


If your car malfunctioned, or you experienced some other issue, what happened:


Maximum number of characters: 1,000


Office Use

Date:

Inspector:

Inspection Report #:

Findings:







Result:

 

  

 




- Home -   |   - Legal Statements -   |   - How to Use this Site -   |   - Contact Us -