SWACCA Unlicensed Contractor Activity Incident Report
This form will be reported to the DBPR Construction Industry Licensing Board to research further.
Which of the following does this involve?
HVAC
Plumbing
Incident Date
-
Month
-
Day
Year
Date
Incident Location
Incident Company Name, if available
Incident Company Contact Info, if available
Complaint Description: Please provide as much detail as possible
I am complaining in my capacity as a:
Please Select
Contractor
Homeowner
Owner of Commercial Structure
Subcontractor
Supplier
Other
If you would like to lodge a complaint with the county officials as well, please provide county name:
Please verify that you are human
*
Submit
Should be Empty: