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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



8/22/2017

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


Notice Regarding Florida Public Records Law Under Florida law, all communications received by this Department are public record unless a specific exemption applies in statute. Please refer to Chapters 455 and 119, Florida Statutes for applicable exemptions.