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DBPR HR-7003 - Division of Hotels and Restaurants Consumer Complaint Form


STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL
REGULATION
2601 Blair Stone Road
Tallahassee, FL 32399-1011


If you have any questions or need assistance in completing this application, please contact
the Department of Business and Professional Regulation or your local district office.
A District Office Address and Contact Information Sheet can be found on H&R's
page of the DBPR web site at www.MyFloridaLicense.com/DBPR



5/24/2017

Section 1 - Establishment Information


License Type: Food Service Lodging Elevator Registered Elevator Company Elevator Inspector

Name:
Address:
City:
County:
State:
Zip Code:
Business Phone:
License Number:
Unit Number (Room/Apartment/Unit number if applicable):

Section 2 - Complainant Information


Last Name:
First Name:
Middle Name:
Title:
Suffix:
Organization Name (If representing an organization, please provide the name of the organization):

Mailing Address

Street Address or P.O. Box:
City:
State:
Zip Code (+4 optional):
County (If Florida Address):
Country:


Contact Information


Primary Business Phone Number:
Primary Home Phone Number:
Primary E-Mail Address:
Does the Complainant want to be contacted? Yes   No

Section 3 - Details of the Complaint



I affirm that I have provided the above information completely and truthfully to the best of my knowledge