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 - Miss Ms Mr Mrs Dr Other… 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.100 MB limit.Allowed types: gif jpg jpeg png. Comments: Store Information How did you find out about our consumer complaint forms? How did you find out about our consumer complaint forms? - None - Online Search Engine (e.g. Google) Community Event Friend, acquaintance, or coworker Brochure/Flyer “Attention Consumers” Yellow Sticker Other… Enter other… Leave this field blank