Customer Request

Please fill in the form below.

If your request involves a safety hazard or an accident has occurred, then immediate response is required: please phone 69412555 between 8:30am and 5pm Monday to Friday, or the duty officer on 0427 470 555 for emergency after hours service.


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Name:*
Property or Business Name:
Street:*
Town or Locality:*
State:*
Phone:*
Fax:
Email:

Customer Request

Request Description:*
Location:*
Request Date:*
Does this request involve a safety hazard?:*
Has an accident or incident occurred?:*

This request requires IMMEDIATE RESPONSE if the answer to either of the above questions was YES. Please telephone 6941 2555