Customer Complaint Form

4 Gleeson Street Clare SA 5453 | After Hours: (08) 8842 6400 | fax: (08) 8842 3624 | Click to email

Use this form to lodge a complaint about any of Council's services

* Mandatory Field

Complaints Form

Title

Surname*

First Name*

Address*

Postcode*

Home Phone*

Work Phone

Mobile

Fax

Email*

Witness Title (if applicable)

Witness Surname (if applicable)

Witness First Name (if applicable)

Witness Address (if applicable)

Witness Postcode (if applicable)

Witness Phone Number (if applicable)

Preferable phone number to be contacted on

Details of Complaint*

In your summary, if applicable, please include date, time, place, people involved and any background information that could be useful

Would you like to be contacted regarding the outcome of your complaint?*

Yes No

Has this complaint been raised with Council before?

Yes No

If yes, please provide any documentation regarding your previous contact

As a result of making this complaint, is there any outcome you would like?*

Yes No

If Yes, please provide details:

If you see this, leave this form field blank.

Email Submitted Data

Send a copy of the submitted form to this email address.

"Clare and Gilbert Valley Councils, vibrant communities working together"