COMPLAINT FORM
STATE OF MARYLAND
DEPARTMENT OF LABOR
DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
500 NORTH CALVERT STREET - BALTIMORE, MARYLAND 21202-3651
HOME IMPROVEMENT .............................................................. 410-230-6309
OCCUPATIONAL AND PROFESSIONAL LICENSING ............. 410-230-6322
TYPE OF COMPLAINT – PLEASE CHECK
HOME IMPROVEMENT
HEATING, VENTILATION, AIR CONDITIONING, REFRIGERATION
OTHER
BOARDS:
PLEASE ADDRESS ENVELOPE TO THE PROPER BOARD/COMMISSION
PLEASE BE ADVISED THAT BY FILING THIS COMPLAINT IT MAY BE NECESSARY FOR YOU TO APPEAR AT A FORMAL
HEARING BEFORE THIS BOARD/COMMISSION OR IN CRIMINAL COURT.
I CAN BE CONTACTED AT THE EMAIL ADDRESS BELOW: YES NO
EMAIL ADDRESS
EMAIL ADDRESS
3.CONTRACT INFORMATION
Did you enter into a contract?
If “YES” was the contract
With whom did you enter into the contract?
(Give name of individual and/or company)
Date of contract (Month, Day, Year)
Did you pay for the services?
4. Name of person who actually did the work or performed the service
Date the work was started
Last date work was performed
Is there an arbitration clause in the contract?
5. Please give a detailed but concise explanation of your complaint in the order in which it occurred and attach any supporting
documents (continue on a separate sheet if necessary. Type or print legibly.)
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE,
INFORMATION AND BELIEF.
(SIGNATURE OF COMPLAINANT) (DATE)
If this is a home improvement complaint and the contractor was licensed at the time of the contract, you may file a
separate claim against the Home Improvement Guaranty Fund.
Form Labor/OPL/P #1 (01-20)
DO NOT WRITE IN THIS SPACE
OFFICE RECORD
_____________________________
BOARD
________________________________
_____________________________
LICENSING INFORMATION
____________________
EXPIRATION DATE
___________________________
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