Customer Request Management Entry
Instructions
Please complete the following form and then select "Submit"
Waste Services - General Waste (Red) Bin Repairs
Name
*
Customer
Name
Title
ALD
CO
CONST
CR
D&M
DR
EST
FR
HON
LT
M&M
M/S
MESD
MESR
MG
MISS
MR
MRS
MS
N
PROF
REV
SEN
SGT
SNRC
SP
SR
U
UNKW
XG
Surname / Company
Given
Contact Details
Residential address
Residential address
Address Line 1
Address Line 2
Suburb
Postcode
Postal address if different from residential
Postal address if different from residential
Address Line 1
Address Line 2
Suburb
Postcode
Work
Home Phone
Mobile
Email
Fax
Customer Preferred Contact Method
Email
Not required
Telephone
Other Contacts
Add
Close
Name
Position
Phone
Fax
Email Address
Property Location Details
*
Search for the property the request is in relation to.
Building
Unit
Level Number
House
Street Name (without type)
Suburb
Title Type
All title types
Lot/Deposited Plan
Lot/Section/DP
Part Lot/Deposited Plan
Part Lot/Section/DP
Strata Plan
Crown Reserve
Proposed Subdivision
CCC Planning Proposal Link
Council sub plan Date Ave
MPO
RES
RESERVE CR
RESERVE PC
Crown Tenure Account Number
Creek Reserve
Private Road
Contaminated Land
Title 1
Title 2
Title 3
Title 4
Title 5
Title 6
Type of Service
(Required)
- -Please Select- -
Commercial
Domestic
Special - Blue Disc
Repair Part
(Required)
- -Please Select- -
Axle
Body
Lid
Lid and Pins
Lid and Wheels
Pins
Wheels
Wheels and Axle
Description
Enter a detailed description of your request
Upload Attachments
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/eservice