PRELIMINARY COMPLAINT FORM Complainant's ... - Collier County [PDF]

PRELIMINARY COMPLAINT FORM Complainant’s Name: ___________________________________ Date: _____________ Address: _________________________ City: ___________ State: ______ Zip: _______ Home Phone: ________________________ Business Phone: ______________________ COMPLAINT INFORMATION: Company Name: _____________________________ License Number: ______________ Contractor or Person in Charge: (If known) ____________________________________ Address: ________________________________________________________________ Phone: ______________________________ Date of Contract: _____________________ COMPLAINT DETAILS: (Attach additional sheets as necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ ______________________________________________________________________________ __________________________________________________________________ Include copies of all appropriate documents: Contracts, checks, liens, permits, etc…

Signature: ______________________________________________________________