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Department of Business Affairs and Licensing
Customer Complaint Form
* Required fields are marked with an (
*
).
Business Information
*
Business Name
*
Business Address
*
Business Status
Existing Business
New Applicant
*
Business Category
>
Restaurant
Night Club
Tavern/Bar
Package Goods Store
Massage Establishment
Billiard Hall/Arcade
Grocery Store
Other
Complaint/Violation
*
Complaint/Violation Type
Overcrowding
Narcotics
Sale to Minor-Alcohol
Sale to Minor-Tobacco
Sale of Loose Cigarettes
Prostitution
Restaurant Operating as a Tavern
Public Indecency
Sale/Possession of Drug Paraphernalia
Sale/Possession of Illegal Weapons
Public Nuisance
Gambling
Other
Describe in detail your complaint(s) regarding the business. Please Include:
Any specific violation of any ordinance or statute
Date and times of violations
Names and addresses of witnesses to the events
Contact Information
(optional)
Name
Street Address
Phone
Email
