FUEL COMPLAINT


Please fill out the following information...then click "SUBMIT" (** indicates a Required entry).
Reason(s) for Complaint:

Note: Complaints regarding fuel advertising or sign pricing need to be submitted to the Oregon Dept. of Justice, Consumer Fraud Section.

Your Name:

  (Name)
  (Address)
  (City, State Zip) ,
  (Contact Phone)
  (email)

FUEL PURCHASE INFORMATION


Station where purchased:
  (Name) **
  (Company/Brand)
  (Address) **
  (City, State Zip) **, ** **
  Date of Purchase: **
  Time of Purchase:
  Payment Method:
  Name or Description of Attendant:
  Type of Fuel: **
 
Pump Number/Location (if quantity complaint):
**
  Did Pump Start at Zero?:
 
Comments:

VEHICLE INFORMATION

  Vehicle Make:
  Model:
  Body Style:
  Year:
 
By clicking the submit button below I agree to the following statement:
I acknowledge and agree that this complaint will become part of our permanent records.
This form is also subject to Oregon's Public Records Law and may be disclosed to persons who request to review its contents.
As such, it may be released to the business or person about whom you are complaining, members of the public, or other agencies if requested.

If you want to be informed of the results of your complaint you must acknowledge that you understand and accept this by clicking the appropriate box.
If you wish to remain anonymous, you must still click the box but do not enter your contact information. You will not be notified of any results if you wish to remain anonymous.