Customer Action Request

Customer Action Request
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail
Object*

FootpathRoadTreeOther
Road name*
Between roads (if applicable)
Town Request is being reported in*

NhillDimboolaRainbowJeparitOther
Detected Location
Option to add photo of defect

Browse Files

Cancelof
Request details*
Reason for request
Upon receipt of your request, an inspection of the defect will be carried out within 7 days. If you would like to be contacted with the outcome of the inspection, please select your preferred correspondence option below.
Would you like to receive a follow up response from Council:*

YesNo
If yes, please select your preferred contact method:

PhoneEmailLetter
Should be Empty: