ConsComplaintForm

Weights & Measures
Consumer Complaint Form
401 State Street Hudson, NY 12534 Phone: 518-697-8291

PLEASE PROVIDE AS MUCH DETAIL AS POSSIBLE IN ORDER FOR US TO INVESTIGATE YOUR COMPLAINT

* Indicates required field

First Name *

Last Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

I have a complaint against:

Daytime Phone *

Email *

Would you like to remain confidential when we contact the business? *

Yes No

Business Name *

Date *

Time *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Type of Complaint *

If Other, please specify *

Type of Fuel *

Octane *

DESCRIBE YOUR COMPLAINT (EMAIL ADDITIONAL INFORMATION/PHOTOS IF NECESSARY): *

Upload File (if necessary) *

Max file size: 20MB

*

I understand under PL 210.45, that making a false written statement is a Class A Misdemeanor, punishable by up to a year in jail.

Submit