Ofce of Arizona Attorney General
Mark Brnovich
2005 N Central Avenue, Phoenix, AZ 85004
Consumer Gasoline Price Complaint Form
Consumer’s Information Gasoline Station’s Information
Name: Name:
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
Details of Purchase
Grade of Gasoline Purchased:
Price per Gallon Paid:
Total Amount of Purchase:
Date of Purchase:
Time of Purchase: