Glenelg Shire Council PO Box 152 Portland VIC 3305 Telephone: 1300GLENELG (1300 453 635) Fax: (03) 55222290
Request for Service and Feedback Form
Use this form to request a service from the Glenelg Shire Council
To: Glenelg Shire Council		Email: enquiry@glenelg.vic.gov.au

I would like to Lodge a request for a Council service Ask a question Make a comment Please provide your contact details Would you like to be contacted about this issue Title MrMrsMissMsDr Given Name * Mandatory Surname * Mandatory Business Name *If Applicable Postal Address Town/City/Suburb Postcode Area Code Business Hours Telephone No. Between 8.30am & 5.00pm AEST Area Code Other Telephone No. E-mail Enter details about your request/question/comment: For requests for service, please ensure that the location of the problem is clearly identified. Enter details here: Protecting Your Privacy Personal and or health information collected by Council is used for municipal purposes as specified in the Local Government Act 1989. The personal information will be used solely by Council for these purposes and or directly related purposes. Council may disclose this information to other organisations if required by legislation. The applicant understands that the personal and or health information provided is for the above purpose and that he or she may apply to Council for access to and/or amendment of the information. Requests for access and or correction should be made to Council's Privacy Officer.