Request for Service

You can use the form below to submit a service request to Erewash Borough Council.

Your enquiry will be dealt with as soon as possible.

You must fill in fields marked with *

Which service does this relate to?: *

Description of enquiry:

Your title:

Your name: *

Your postcode: *

Your address: *

Your daytime telephone number: *

Your evening telephone number: *

Your email address:

Data Protection: This form is not secure. Please don't include any confidential or sensitive information on it. We will treat any other personal information you provide in confidence and under the Data Protection Act 1998. We will hold it and only use it for a legal reason or for the purpose it is given. We will only share information when we have your consent or we need to ask another department or partner to respond to a specific comment or request you have made.

We will keep a record of the sender's Internet Protocol address (which is unique to the sender's computer), the date we received the form, and the content for back-up and archive purposes. We will also use this record to identify senders of any malicious content under the Protection from Harassment Act 1997. We will keep this record for a maximum of three months.

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