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Division of Rehabilitation and Liquidation

Contact Us

Complete the form below! You can still write a letter or call, at the address and phone number listed below.

     Florida Department of Financial Services                   Phone: 800-882-3054
     Division of Rehabilitation and Liquidation
     PO Box 110
     Tallahassee, Florida 32301   

  *Denotes Required Field
First Name is required.3 is the minimum number of characters.20 is the maximum number of characters. *
Last Name is required.3 is the minimum number of characters.20 is the maximum number of characters.*
Email is required.Invalid format. Example: you@domain.com*
Example: 000-000-0000
Phone Number is required.Invalid. Example:000-000-0000* Example: 000-000-0000
Address is required. 5 is minimum number of characters.30 is maximum number of characters.*
 
 
City is required. 3 is minimum number of characters.20 is maximum number of characters.*
State is required.2 is minimum number of characters.2 is maximum number of characters.* Example: FL
Zip Code is required.Invalid. Example: 00000*Example: 00000
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Customer Type *
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*
Receivers Identification Number