	South Gippsland Shire Council 9 Smith Street (Private Bag 4) 3953 ABN: 67 816 770 786 Telephone: (+61 3) 5662 9200 Fax: (+61 3) 5662 3754
Customer Request Form

To: southgippsland.vic.gov.au

Request Form

What happens to your request?
A Customer Service Officer will enter your request into our Electronic Request System (where it will be given a number for tracking its progress) assessing and actioning accordingly. Emergency issues will receive immediate attention and other requests are prioritised and completed once they are deemed necessary and Council's responsibility.

Address or Location to be Reviewed:

Maintenance - (road, drainage, footpaths)

Choose a Maintenance options:
(if Maintenance above was ticked)

Parks and Gardens

Choose a 'Parks and Gardens' options:
(if 'Parks and Gardens' was ticked)

Other Areas:

Health & Family ServicesPlanningRubbish and RecyclingOther

Details of your Request:
(Please be as concise as possible) * Mandatory

Name of Requester:

Address of Requester:

Daytime Contact Telephone Number:

Email Address: