B5 Problems in the State of Minnesota

 All fields must be filled out.                                         

  Date

  Company Name/Occupation

  Location

Description of problem

  Type of equipment with problem

  Appearance of material clogging filter

  Name of person submitting form

  Phone number for any questions we may have on information.

Please press submit button at top of form. 

Form is being submitted to the Minnesota Petroleum Marketers Association.

Thank you!!