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Rockhampton Regional Council
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Maintenance Request
Please provide as much detail as possible about your repair requests.
Contact Details
Date:
Name:
Home Number:
Work Number:
Mobile Number:
Email Address:
Preferred Contact:
Select a preferred method of contact
Contact me by Home Phone
Contact me by Work Phone
Contact me by Mobile Phone
Contact me by E-mail
Maintenance Details
Name of Property Manager:
Property Address:
Repairs Required:
Access for Tradesperson:
Call to arrange access
Use the Agency's key
Note: fields marked with a
bold label
are required to submit this form.
