Waimate
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Fix-a-gram

Please use this form to identify any problems or hazards which you would like to make known to us.


Problem:
Other problems or comments:
*
Exact location of problem:
*
First name:
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Last name:
*
E-mail address:
*
Daytime phone number:
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Street/Road/Rapid number: *
Street/Road name: *
Town/Rural location: *
 
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