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Waste - Service request form

Kirklees Direct - August 2011
waste@kirklees.gov.uk

Using this form below to report waste problems, request services, application forms and further information. Please fill in all parts of this form which are marked with a *.

Please note:
This service exists solely for the purpose of resolving issues relating to the area covered by Kirklees Council, England. Please refer to this map which covers the Kirklees area.

Your details

Title (Mr, Mrs, Ms, Dr etc)
First Name *	e.g. Robin
Last name *	e.g. Jones
Property name/number *	e.g. 10
Street *	e.g. Crown Street
Location	e.g. Golcar
Town	e.g. Huddersfield
Postcode *	e.g. HD7 1EP
Telephone No. (including area code) *	e.g. 01484 221000
Fax Number (including area code)
Email Address	e.g. robin.jones@kirklees.gov.uk

About your request

Your request* (Please give us as much information as possible so we can ensure it is dealt with efficiently.)
Location of problem* (Please give as much information as possible, such as an exact location for example, property number, nearest junction, road name etc.)

Contacting you

On some occasions we may need to contact you for further information. Please tell us how you would like us to contact you.

Preferred contact method*

[Email: ] [Letter: ] [Telephone: ] [Fax: ] [I do not want to be contacted: ]

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