Customer Request Form

Customer Details

Preferred contact method*This field is required.

Service Department

Please select one of the following*This field is required.












Complaint Details

To the best of your knowledge is this request related to*This field is required.






















If the complaint is relating to noise, which category best fits your request?












Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx
Have you attempted to resolve this matter yourself?*This field is required.
text confirmation

I wish to lodge this customer request and everything stated on this form is true and correct.

text please note

Please Note:

  1. The Town of Port Hedland receives a large number of requests relating to various matters and these are dealt with in order of receipt and priority, such as risk to the public health and safety.
  2. Anonymous requests will only be investigated in exceptional or emergency circumstances
  3. The Town of Port Hedland is subject to the Freedom of Information Act 1992.
  4. Should legal action be necessary, you may be required to give evidence in Court.
Get Audio Code