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Complaint Form
Complaint Form
IMPORTANT: Before you begin, make sure you have digital copies of all contracts (front and back), proposals, canceled checks (front and back), invoices, receipts, advertisements, business cards, correspondence, permits, etc. Accepted formats include pdf, jpg, gif, or png. Incomplete and unsigned forms will not be processed.
Please note all fields are required. If the information for an entry is unavailable, please enter "N/A".
Complainant Information
Name of individual filing complaint
*
Required
First
Last
Company Name
*
Required
Complainant Address
*
Required
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Complainant Phone
*
Required
Complainant Email
*
Required
Contractor Information
Contractor Name (As shown on contract/invoices)
*
Required
First
Last
Contractor's Company Name. If none exists, please enter "N/A"
*
Required
Contractor's License Number Used. If none exists, Enter N/A
*
Required
Contractor's Address
*
Required
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contractor's Phone
*
Required
If unavailable, please enter "N/A"
Contractor's Email
*
Required
Nature of Complaint
Residential or Commercial
*
Required
Select One
Residential
Commercial
Residential
*
Required
Unlicensed Residential Construction or Remodeling
Gross Negligence or Misconduct
Failure to pay for Goods or Services
Loaning a License to an Unlicensed Person
Engaging in Work on an Expired or Suspended License
N/A
Commercial
*
Required
Unlicensed Commercial Construction
Bidding or Contracting Without a License
Irresponsible
N/A
Nature of Irresponsibility
*
Required
Failure to pay for goods or services
Failure to verify license of a subcontractor
Other
N/A
Other Irresponsibility
*
Required
Project Information
Physical Address
*
Required
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Project Type
Choose Residence or Commercial
*
Required
Residence
Commercial Building
Residence
New Construction
Remodel
Commercial Building
New Construction
Remodel
Contract Date
*
Required
MM slash DD slash YYYY
Amount of Contract
*
Required
Amount Paid on Contract
*
Required
If unavailable, please enter "N/A"
Date work started
*
Required
MM slash DD slash YYYY
Date work ceased
*
Required
MM slash DD slash YYYY
Contract type
*
Required
Choose from the dropdown
Select Written or Oral
Written
Oral
If written, attach a copy of the contract
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Change Orders
Were there any change orders?
*
Required
Yes
No
If Yes, were the change orders
Choose one
Written
Oral
Both
If written, attach a copy of the change orders
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Why did you choose this contractor?
*
Required
Regular Customer
Door-to-Door Solicitation
Referred by Someone
Advertisement
If "advertisement" attach a copy if possible
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Building Permits
Building Permits Obtained By
*
Required
Contractor
Owner
Do not know
Not required
Attach Building Permit if Available
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Name of Building Department
*
Required
If unavailable, please enter "N/A"
Inspections
Were any inspections performed?
*
Required
YES
NO
If "yes", by whom and when?
Please upload any documents relating to your inspection
Drop files here or
Select files
Max. file size: 256 MB.
Contacting the Contractor
What attempts have been made to contact the contractor?
*
Required
Unable to Locate
Personal Contact
Telephone
Letter (attach copies below)
Attach copies of letter
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Have you notified the contractor in writing of the issues in dispute?
*
Required
YES
NO
If "yes", attach copies of written notice
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Have you obtained an estimate from another contractor to correct/complete the project?
*
Required
Yes
No
If yes, attach copies of the estimate
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Have you had the job corrected or completed?
*
Required
Yes
No
If yes, attach copies of the contract and proof of payment
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Liens
Were any liens filed on this job?
*
Required
Yes
No
If yes, attach copies of lien document
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
If you have other relevant documents or photos you’d like to include, please upload here
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 256 MB.
Amount of Lien:
*
Required
If unavailable, please enter "N/A"
Person who filed the lien:
*
Required
If unavailable, please enter "N/A"
Description of Complaint
State your complaint in the space below:
*
Required
PLEASE SEND COPIES OF ALL PAPERS RELATED TO YOUR COMPLAINT
You MUST attach COPIES of all necessary supporting documents. For residential complaints, attach copies of all contracts, proposals, receipts, proofs of payment, permits, if in a permitted area, photos and/or home inspections. For commercial complaints, attach copies of all contracts, bids, or bid tabulation forms as well as receipts, statements, invoices and/or payments. DO NOT SEND ORIGINALS. If copies are not available, please explain.
The contractor will be informed of this alleged complaint and will be asked to respond. The Mississippi State Board of Contractors cannot direct a contractor to complete or correct a project. The Mississippi State Board of Contractors cannot represent private citizens in court or collect money for you. Please contact an attorney or your local court for advice on filing such an action.
By signing this complaint form, I hereby swear or affirm that the above statements are true, correct and complete to the best of my knowledge. I will assist in the investigation of this complaint and if necessary, attend hearings and testify to facts. I understand that failure to cooperate with the investigation may result in dismissal of the complaint.
Signature
*
Required
Please type your name
Date
*
Required
MM slash DD slash YYYY
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