Request For Service Form

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Request For Service Form

Request for Service Form for Dunedin City Council Water and Waste Business Unit

Problem Description

Caller Details

Title

First Name

Middle

Last Name *

Caller's Address

Street No. *

Address *

Suburb *

Address of Problem (if different)

Street No.

Address

Suburb

Do you have an email address so we can provide electronic updates to you?

Contact Phone Numbers

Daytime *

Mobile

After Hours

Description of Problem

Network Type

Select Network * Water
Wastewater
Stormwater

Select a Network Type

Water Network

Problem Menu

Nature of Water Problem *

What is the nature of the service requested or problem?

Priority

Automatically Assigned

Additional Information

Any further information?

Wastewater Network

Problem Menu

Nature of Wastewater Problem *

What is the nature of the service requested or problem?

Priority

Automatically Assigned

Additional Information

Any further information?

Stormwater Network

Problem Menu

Nature of Stormwater Problem *

What is the nature of the service requested or problem?

Priority

Automatically Assigned

Additional Information

Any further information?