Service Request Form

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Using the Online Service Request Form

Enter information about your service request

Specify the nature of your request or comment.

Select the topic from the drop down list.

Enter your comments and/or the description of the problem or service request in detail in the box.

Enter the address/location of the problem or service request. If the service/problem has a street address, enter it. If the service/problem is at an intersection, enter the names of the cross streets in the box and specify exact location (i.e., northeast corner) at the intersection.

Click "Submit"

The online Service Request form should not be used to report bylaw infractions or emergencies or safety or health hazards. For bylaw infractions, contact the Bylaw Services Office at 604.927.5440 or bylawservices@portcoquitlam.ca
If you have difficulty using this form, please contact our Information Desk at 604.927.5411 or info@portcoquitlam.ca .

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I am reporting a:

Service Request	Complaint	Compliment	Comment
Inquiry

Subject

Enter description/details. Specify the address or location in the box below.

Address/Location (Specify the address or intersection where applicable.)

Tell us how to contact you.

Name

Telephone

Enter a valid phone number. Example: 123-456-7890

Enter a valid email address. Example: name@company.com

Address

Please contact me as soon as possible regarding this matter.

Check if applicable.