Suspect a problem with a service station or a fuel pump? Fill out service station complaint form. * Required Fields Contact Information Your Name Title Title - None -MissMsMrMrsDrOther… Enter other… First Middle Last Suffix This information is confidential, but needed in order to ensure timely response to the complaint. Address Address City/Town Phone Email Address Station Information Station Name Date of Incident Station Address Address City/Town Near Cross Streets Pump Number Grade Fuel Type Receipt Scan One file only.2 GB limit.Allowed types: gif, jpg, jpeg, png. Comments: Store Information CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.