Service request

Please use this form to report any issues which require council attention. Only use this form for one issue at a time, as each request will be actioned individually. Please do not use this form for urgent or hazardous situations. Phone 03 6254 5000 in these instances.

Your details

First name *

Last name *

Preferred method of contact *

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Email address

Telephone *

Postal address *

Address *

City *

State *

Postcode *

Service request details

Please provide as much detailed information as possible, including relevant times, dates, addresses etc. You may include some photos if you wish to help describe the request. You may add up to three photos.

Description of information/service request *

Photo 1

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Photo 2

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Photo 3

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Consent and form submission

I consent to the Southern Midlands Council using my information to fulfill my request. View the Southern Midlands Council privacy policy. *

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