Customer Request Management Entry

Instructions

Please complete all relevant sections of the form

Please note:
Changing your email address with Council will update all Council email contacts including Rates and Water Notices via email.
Only one email address can be held for the owner of single or multiple properties.

Animal registration cancellation

Animal Name Details *

Customer

Name

Code

Surname *

Given Name * / Second Name

Contact Details

Postal address

Street address line 1 *

Street address line 2*

Street address line 3

Postcode *

Postal address if different from residential

Street address line 1 *

Street address line 2*

Street address line 3

Postcode *

Work phone

Home phone

Mobile phone

Email address *

Alternate phone

What is your preferred method of contact?

Not required

Telephone

Animal "kept at address" (Required)

Animal name (Required)

Preferred contact number (Required)

Animal reference number

Animal tag number

Cancellation date (dd/mm/yyyy) (Required)

Reason for cancellation (Required)

I have read and accept the terms and conditions of use for Council's online self services. (Required)

Yes

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