Online Form - Service Request

Please complete this form to report any issues relating to Shire-owned infrastructure or request Shire assistance.

For urgent after hours enquiries, please phone the Shire 24 hour line on (08) 9883 4999.

Full Name*

Email Address*

Phone Number*

Please select an appropriate category relating to your request*

Please provide a description of the issue*

Exact location of the issue (including the nearest cross road if applicable)*

If you have a photo, please attach it here

Max File Size: 10.00 MB
Allowed File Types: .jpg, .pdf, .png

Would you like to be contacted on the progress of this report?*

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