Consumer Complaint Form
Download a blank fillable Consumer Complaint Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Consumer Complaint Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Please return completed complaint form
Florida Department of Agriculture and Consumer Services
to:
Division of Consumer Services
FDACS
Mediation & Enforcement
2005 Apalachee Parkway
CONSUMER COMPLAINT FORM
Tallahassee, Florida 32399-6500
Section 570.544(4), Florida Statutes
ADAM H. PUTNAM
1-800-HELP-FLA (435-7352) FL Only
COMMISSIONER
(850) 410-3800 Calling from Outside FL
This information MUST be provided for the department to mediate your complaint, as we correspond via U.S. mail. Incomplete
forms CANNOT be processed. PLEASE WRITE LEGIBLY. Only one business per complaint form.
Person Making Complaint:
Complaint is Against:
Ms. / Mrs. / Mr.
Last Name, First Name, Middle Initial
Name of Business
Mailing Address
Mailing Address
City, State, Zip Code and Country
City, State, Zip Code
Home and Business Phone, including Area Code
Business Phone, including Area Code
Email Address
Business Email and/or Web Address
Please check if you would like to receive our Florida Consumer E-Newsletter. Our newsletter provides monthly consumer tips
and information and is distributed by email.
Because certain age groups enjoy specific protections under the law, please select the box next to your age group:
25 – 35
36 – 45
46 – 55
Under 25
Over 55
Product or Service involved:
Amount Paid: $
Refund or Restitution Amount You Are Requesting: $
Date of Transaction:
I was contacted by:
Telephone
Mail
Other
Have you retained an attorney?
Yes
No
Have you filed suit in court?
Yes
No
If yes, you should rely on the advice of your attorney.
Did you sign a contract or other papers, i.e. estimates, invoices, or other supporting documents?
Yes
No
PLEASE ATTACH COPIES, DO NOT SEND ORIGINALS.
All documents and attachments submitted with this complaint are subject to public inspection pursuant to Chapter 119, F.S.
Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his
official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in Section 775.082, 775.083, or
837.06, F.S.
FDACS–10000 Rev. 08/14
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal