Customer Service Request and Feedback Form

This form can be used to request a Council service or to provide feedback on a Council activity. Required fields are marked with an asterisk (*).

Date *

Day Month Year

Your Name *

Property Address *

Postal Address

Email address

Phone number *

Is this a Request for Service? Please enter details here

Is this a Complaint? Please enter details here

Is this a Comment? Please enter details here

Has the matter been referred to a Council employee or discussed with a staff member before? *

Please tell us if you would like a response to your feedback from District Council of Coober Pedy? *

Please attach a photo if relevant

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