Office of Consumer Protection Complaint Form

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Consumer Complaint Form
Online Gasoline Prices and/or Gas Station Complaint Form

* Indicates Required Field

Complaint Reported By:
Last Name: , First Name: (Your name will be used as your case identifier/tracker.)
Street Address:
City: , State: ZIP Code:
Telephone Number(s): Home: Daytime:
E-Mail Address:

Complaint Reported Against:
Business Name:
Street Address:
City: , State: ZIP Code:

Do you have any credit card or other receipts related to the transaction?
Yes No

Describe the facts of your complaint.

By submitting this complaint form, I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. In addition, I authorize the New Jersey Division of Consumer Affairs to send this complaint form to the company or to interested parties and to use the information in any way that is necessary.


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Consumer Complaint Form Online Gasoline Prices and/or Gas Station Complaint Form

Consumer Complaint Form
Online Gasoline Prices and/or Gas Station Complaint Form