Error processing SSI file

Request a Complaint Form

Note: The Complaint Form is also available for download in Adobe Acrobat ".pdf" format. Adobe has a free Reader program to view and print the forms.

The Complaint Form includes instructions and a checklist.




Helpful Links


* Indicates a required field

Licensed Complaint Form (for Current or Suspended Licenses)

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

Send of the form(s) to:
Note: A separate complaint form is required for all contractors involved in each complaint.

* First Name: * Last Name:

* Street Address:

* City: * State: * Zip:

Do you have access to a printer? Yes No

Optional Contact Information
Email: Telephone: Fax:



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



Error processing SSI file