Gas Gouging Complaint

Filing a Gas Price Complaint

First Name:

Last Name:

Email Address:

Street Address:  

City: State: Zip:

Phone Number:

Gas Station Name:

Gas Station City:

Gas Station County:

Gas Station Location - Cross Streets/Coordinates 

Date you witnessed the incident (Price):

Approximate time you witnessed the incident (Price:)
am pm

What was the price per gallon that you saw?

Grade of Gasoline?

Are you willing to testify in court regarding complaint?

Comments: