Government of the Virgin Islands of the United States Department of Licensing and Consumer Affairs “Serving Businesses and Assisting, Educating, & Protecting Consumers” www.dlca.vi.gov Golden Rock Shopping Center Administrative Complex Property & Procurement Building 3000 Estate Golden Rock, Suite 9 “The Battery” 8201 Sub Base, Suite 1 St. Croix, VI 00820-4311 St. John, VI 00830 St. Thomas, VI 00802-5826 Telephone: 340.713.3522 Telephone: 340.693.8036 Telephone: 340.714-3522 Facsimile: 340.718.6982 Facsimile: 340.776.6989 Facsimile: 340.776.8303 To: Office of the Commissioner Department of Licensing and Consumer Affairs Business Name:____________________________________________________________ Address: _____________________________________________________________ _____________________________________________________________ Telephone #: _____________________________________________________________ Fax #: _____________________________________________________________ NOTICE TO CHANGE PRICE OF FUEL My wholesale/retail establishment recently purchased fuel from_______________________, as evidenced by attachment of invoice(s) #______________. Therefore, pursuant to DLCA’s Order Setting Forth the Procedure for Increase of Fuel Prices, I request to change the price of fuel as indicated below: PRODUCT CURRENT PRICE CHANGE NEW PRICE Regular Premium Diesel Propane NOTE: SUBMIT COPY OF MOST RECENT INVOICE AS PROOF OF PURCHASE. Owner/Manager_______________________________________________________________ NAME (PRINT) ___________________________________ ____________________________________ SIGNATURE DATE FOR OFFICE USE ONLY [ ] APPROVED [ ] DISAPPROVED ________________________________ __________________ Commissioner Date Department of Licensing and Consumer Affairs