FixIt - Online Service Request

Posted Mon, 28/03/2011 - 14:18 by jill

Do you have a Council related problem that requires attention? Please fill out the form below or contact one of our Council Offices.

LOG A REQUEST FOR SERVICE ONLINE

FOR URGENT ATTENTION

For problems requiring URGENT ATTENTION please contact the Council now by phone or in person.

For less urgent problems you may contact the Council directly or log a request for service online by completing the following form.

PROBLEM

The problem involves: *

LOCATION OF THE PROBLEM

House No.:

Street name:

Town: *

Other (if no street address):

DESCRIPTION OF THE PROBLEM

Please describe the problem: *

YOUR DETAILS

Title: *

Name

Firstname: *

Surname: *

Address

Same location as above:

Yes

House No.:

Street name:

Town:

Phone Numbers

Home: *

Work:

Mobile:

Email address (if you supply an email address a copy of the information you submit in this form will be emailed to that address):

Do you wish to be contacted about this issue: *

Yes