Customer Request Management Entry

Instructions

Please complete the following form and then select "Submit"

D&EC - Illegal Dumping

Name *

Customer

Name

Title

Surname / Company

Given

Contact Details

Residential address

Address Line 1

Address Line 2

Suburb

Street address 4

Street address 5

Postcode

Postal address if different from residential

Address Line 1

Address Line 2

Suburb

Street address 4

Street address 5

Postcode

Work

Home Phone

Mobile

Fax

Customer Preferred Contact Method

Not required

Telephone

Property

Search for the property the request is in relation to.

Building

Unit

Level Number

House

Street Name (without type)

Suburb

Title Type

Title 1

Title 2

Title 3

Title 4

Title 5

Title 6

Street

Select a Suburb and Street the call is in relation to.

Select Street

Select Suburb

Description

Enter a detailed description of your request

Is it private or public land? (Required)

What has been dumped? (Required)

When has the dumping occurred/occurring: (Required)

Do you have any photographic evidence: (Required)

Yes

Comment:

Do you have vehicle or registration details? (Required)

Yes

Comment:

Upload Attachments

Upload an attachment from your computer to link to this request.

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