Skimmer Form

Instructions

Please provide as much information as possible to explain why you believe there is a skimmer at the location you are reporting, including photos of the fuel dispensers, your receipt, facility information, and/or other evidence.

Indicate if you are a member of the public, law enforcement, merchant, or a service technician?
Incident Details
The Date of Incident field is required.
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Was merchant notified?
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Complainant's Information

Do you want to remain anonymous?

If you check "Yes" your complaint will be submitted anonymously, If "No" is selected your contact information will no longer be considered anonymous and your information may be subject to release under the Public Information Act, Chapter 552 of the Texas Government Code.
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Attachments

Include pictures of skimmer(s), fuel dispensers, your receipt, facility information, and/or other evidence.

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