Online Form - Appeal an Infringement

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 Shire of Denmark on (08) 9848 0300

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

Contact Details

Title

Given Names *

Last Name *

Company Name

Contact Phone Number *

Email Address: *

Residential Address *

Postal Address (if different from residential)

What is your preferred method of receiving correspondence

EmailPostTelephone

Infringement Number (required) *

Date of Infringement (required) *

Provide a reason for your appeal *

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