Customer Request Form

The Customer Request Form allows you to log a query to Council at any time. To log a request with Council please complete all of the fields and then click the submit button. Your request will be immediately sent through to the relevant Council staff member.

* Mandatory Field

Date of Request

Name of Person Requesting Request

Address

Phone Number

Email address

Brief Details of Request*

Location*

If you see this, leave this form field blank.

Email Submitted Data

Send a copy of the submitted form to this email address.

If you would prefer to download a copy of the Customer Request Form to complete, please click here

Customer Request Form

Contact

Bordertown Office

Keith Office