Online Customer Complaint Form

All personal details remain CONFIDENTIAL Complaints will be acknowledged within 5 working days of receipt and a resolution within 15 days

* Mandatory Field

Customer Complaint Form
Name of person making complaint*
Residential address*
Postal address*
Contact number/s*
Email

Complaint Details

Date of incident (if relevant)
Time
Location of incident
Who/what is the subject of your compliant
Summary of complaint/issue

Witness Details (if applicable)

Name
Address
Daytime contact number

Complaint Outcome

As a result of making this complaint, is there any outcome you would like?*
If yes, please provide details

Upon submitting 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

I agree
If you see this, leave this form field blank.
This is a printer friendly version of the following web page:-
http://www.portaugusta.sa.gov.au/page.aspx?u=1200