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. DBPR 0070 Uniform Complaint Form .
.
. State of Florida Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0783
. If you have any questions or need assistance in completing this form, please contact the Department of Business and Professional Regulation, Customer Contact Center, at
(850) 487-1395.
.
MAILING ADDRESS
COMPLAINANT INFORMATION
Last Name
First
Middle
Title
Suffix
Your Company/Occupation
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
Unlicensed Activity Complaint?
Yes No Unknown
COMPLAINT DESCRIPTION
.