In order for the Texas Department of Agriculture to pursue an investigation of a complaint please provide all information related to your complaint, including a complete explanation of your complaint.


Incident Details:


Date of incident: 

* Feedback or information to offer: 

* Grade of fuel: 

* Pump Number 

Incident business name: 

Incident business license ID: 

Name of contact at location: 

* Street: 

* City: 

County: 

State: 

Zip: 


Your Details:


Do you wish to  
remain anonymous?  

Preferred  
contact method:  

Prefix 

* First Name 

MI 

* Last Name 

* Address Line 1 

Address Line 2 

* City 

* State 

* Zip 

* Email 

Phone