Complainant Name First Name Last Name Telephone Email Address Do you wish to remain Anonymous? Yes No Establishment in Question establishment_name Establishment Name establishment_address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Email Address Telephone Complaint Type Scales Electric Meter Weighmaster Gas Station Scanner Vapor Meter Fuel Quality LPG Misc. Device Packaging Retail Water POS Retail Meter Other If Gas Station Pump# Grade or Product of Fuel Purchased: Date of Occurrence: Did you attempt to resolve this with the Establishment in Question? Complaint Description Upload Image One file only.256 MB limit.Allowed types: gif, jpg, jpeg, png. Upload Image One file only.256 MB limit.Allowed types: gif, jpg, jpeg, png. Upload Document One file only.256 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. CAPTCHA
