Customer Complaint Form printable pdf download

Customer Complaint Form

CUSTOMER COMPLAINT FORM

All sections as marked

are to be completed prior to lodging form at Council

All personal details remain CONFIDENTIAL

Complaints will be acknowledged within 5 working day

of receipt and a resolution within 15 days

*Name of person making Complaint

*Residential Address

*Postal Address

*Contact Number/s

COMPLAINT DETAILS

Date of Incident (if relevant)

Time

Location of Incident

Who/What is the subject of your Complaint

Summary of Complaint/Issue

WITNESS DETAILS (if applicable)

Name

Address

Daytime Contact Number

COMPLAINT OUTCOME:

Yes 

No 

As a result of making this complaint, is there any outcome you would like?

If yes, please provide details

Upon signing this form I agree that should legal proceedings be required I will

APPEAR IN COURT AS A WITNESS TO GIVE EVIDENCE TO THE TRUTH OF THIS COMPLAINT

*Complainants name

(signature)

(date)

Lodge written Complaint:



By posting to Port Augusta City Council, PO Box 1704, PORT AUGUSTA SA 5700



Faxing to (08) 0841 0357



Emailing to

admin@portaugusta.sa.gov.au

F10/2945 - AR11/5432

Customer Complaint Form