Licensing Regulation & Enforcement
2725 Judge Fran Jamieson Way, Bldg. A-114
Viera, Florida 32940
Phone: (321) 633-2058, press 4, 6
contractorlicensing@BrevardFL.gov
COMPLAINT FORM
Please return this completed form and copies of any related documents such as
contracts, cancelled checks, etc. to the above address. Your complaint will be reviewed
and an investigator will contact you.
COMPLAINANT
Your Name:
Address:
(City) (State) (Zip Code)
Phone #: Email:
LOCATION OF ALLEGED COMPLAINT:
(City) (State) (Zip Code)
SUBJECT OF COMPLAINT
Contractor/Firm Name:
Address:
(City) (State) (Zip Code)
Phone #:
Did you sign a contract? YES NO Date:
An attempt will be made to assist you and the contractor in negotiating a resolution
whenever possible. If this is not possible, other actions may be taken depending on the
result of the investigation. Florida statutes 837.06, False Official Statements: 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.
SIGNATURE:
Office Use Only: Investigator Initials: _______ Case #: ____________ Date: ___________________
DATE:
