Customer Request Management Entry


Please complete the following form with as much details as you can to help us process your request in a timely manner. This form is only to be used for non-urgent requests. For any urgent or dangerous issues, please call the City of Rockingham on (08) 9528 0333.

Please note that we take your privacy seriously and will not disclose your details to any third party without prior permission.

General Enquiry / Request


Please enter details of your enquiry / request *

Property Description

Search for the property the call is in relation to.

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    Select the Street and Suburb from the drop-down fields below that your request is in relation to.

    Your Details - Please provide as much information as possible *


    Contact Details

    Residential address

    Residential address

    Postal address if different from residential

    Postal address if different from residential

    What is the preferred method of receiving correspondence?

    Upload attachments

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