Request a Complaint Form

Forms Requested

Licensed Complaint Form (for Current or Suspended Licenses)

Unlicensed Complaint Form (for Unlicensed Entities or Revoked/Expired Licenses)

Non-Payment Complaint Form

Number of copies to send

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Do you have access to a printer?

Yes

Did you know you could download the form as a PDF? You can download any of the complaint forms from our Forms page or by clicking here. You can then fill it out on your computer, print it and send it in.

Telephone

Fax

After submitting this form, you should expect to see a confirmation page. This will notify you that your request has been received.