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Fly Tipping Requests/Complaints

Please complete as many fields as possible. Mandatory fields are shaded yellow in Internet Explorer or identified by a '*' symbol for Netscape viewers.
Location of Refuse:	*
Description of Deposited Material:	*
Time of Occurrence:
Date of Occurrence:
Description of any Vehicle involved :
Other Details:
DETAILS OF THE COMPLAINANT
Title:	Forename:	Surname:
Address Line 1:
Address Line 2:
Town:
Post Code:
Telephone Number:

DETAILS OF WITNESS TO THE ACT (IF DIFFERENT FROM ABOVE)
Title:	Forename:	Surname:
Address Line 1:
Address Line 2:
Town:
Post Code:
Telephone Number:
"Is the witness prepared to give a statement to support legal proceedings?"