CX01 - Customer Feedback Form The 91视频 is committed to giving our customers the best possible service. We welcome your suggestions, enquires and feedback on our service, whether positive or negative. If something is wrong we will try to put it right. It is our intention to use the feedback to continually improve upon everything we do. Applicant Details Name*This field is required. Residential Address*This field is required. Telephone Number*This field is required. Postal Address Alternate Contact Number Email Address*This field is required. Feedback Nature of Feedback*This field is required. Select an Option Comment/Suggestion Complaint Compliment Request for Information/Service Would you like a response?*This field is required. YesNo Please provide as much detail as possible*This field is required. If you require a Rates Reimbursement, please complete RA14 - Rates Reimbursement. Supporting Documentation Attach any relevant documentation or images: Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx Thank-you for your feedback. Please be assured that all information provided by you is treated with the utmost confidentiality. I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application*This field is required. YesNo Signature*This field is required. The 91视频 collects the personal information you provide in relation to the Customer Feedback Form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at privacy@cgg.wa.gov.au. Type the code from the image: Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. Type the code from the image: Do not fill this textbox.