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Please complete this form to report any issues relating to Council-owned infrastructure or request Council assistance.

For urgent after hours enquiries, please phone the City 24 hour line on 08 9781 0444.

First Name*

Last Name*

Phone Number*

Email*

Please select an appropriate category relating to your request*

Please provide a description of the issue*

Exact location of the issue (including the nearest cross road if applicable)*

If you have a photo, please attach it here

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Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

I have read and understood this form and to the best of my knowledge have provided true and correct information*

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City of Busselton

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