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. DBPR HR-7003 Division of Hotels and Restaurants Consumer Complaint Form
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. SECTION 1 ESTABLISHMENT INFORMATION
. License Type: Food Service Lodging Elevator Registered Elevator Company Elevator Inspector
Name
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Address
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City

County

State

Zip Code
Business Phone:
License Number:
. SECTION 2 COMPLAINANT INFORMATION
. Last Name First Middle Title Suffix
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. Organization Name (if representing an organization, please provide the name of the organization)
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. MAILING ADDRESS
Street Address or P.O. Box
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Zip Code (+4 optional)
City
State
County (if Florida address)
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. Country
. CONTACT INFORMATION
Primary Business Phone Number

Primary Home Phone Number
Primary E-Mail Address
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Yes
Does the Complainant want to be contacted? No
. SECTION 3 DETAILS OF THE COMPLAINT
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