Consumer Complaint Form Page 2
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2Please explain your complaint. Attach additional sheets if necessary.
**What would satisfy your complaint?
**The department cannot require businesses to take a particular action such as repairing or replacing a product, or refunding money. The
department may act as a mediator to attempt dispute resolutions; however, on occasion, the only recourse is to seek legal remedy through the
court system.
My signature authorizes the Department of Agriculture and Consumer Services to take any action deemed necessary for
purposes of mediation, investigation or enforcement. I understand that the department does not give legal advice, and
cannot take legal action for me. I am filing this complaint to notify the department of the activities of this business/
individual and to seek any assistance available. I ACKNOWLEDGE THAT I AM AWARE THAT THE PERSON/ BUSINESS
WHICH I AM COMPLAINING AGAINST WILL RECEIVE A COPY OF THIS COMPLAINT.
Signature:
Date:
I am filing this complaint for information purposes only and DO NOT want mediation assistance.
My personal information is exempt from public records disclosure because I am a sworn law enforcement officer,
judge, or other individual specifically exempted by s. 119.071(4), F.S.
FDACS–10000 Rev. 08/14
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