Resources complaints form

Full name *

Address

Phone number * (include area code)

Mobile

Email

Preferred contact

Individual or company name

Address

Please select the relevant resource activity *

Issue category * Select one or more category.

Please specify

Details of complaint Describe the issue, including date and time

Site address If different from above.

Have you contacted the person/company/business about the problem? *

Do you give permission for your details to be released to a third party if the matter needs to be referred? *

I declare that the above information I am supplying is true and correct *

Landholders and community