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First name
Last
Phone
Email
Street
City
State
Zip Code
YesNo
Business Name Street
ZIP code
Type of Complaint —Please choose an option—Motor FuelScaleShort Weight/MeasurePrice OverchargeOther
If other, please specify
Type of Fuel —Please choose an option—DieselGasoline
Octane —Please choose an option—87899193E85Non-Ethanol
Date
Time
Please describe your complaint
I understand under PL 210.45, that making a false written statement is a Class A Misdemeanor, punishable by up to a year in jail.
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