Required fields are marked with asterisks (*)

Accessible Customer Service Feedback

Thank you for taking time to provide feedback. We value all of our customers and visitors, and strive to meet everyone's needs. Contact our Clerk at jnethercott@westelgin.net or call 519-785-0560 ext. 222, if you have questions or need more information.

Notice of Collection of Personal Information

The personal information collected on this form is collected under the authority of the Customer Service Standards of the Accessibility for Ontarians with Disabilities Act and will be used to improve customer service within the Municipality of West Elgin. Questions about the collection should be addressed to the Clerk at 22413 Hoskins Line, Rodney ON N0L 2C0, 519-785-0560 ext 222 or clerk@westelgin.net

Date and Time:

Staff Member:

Department:

Municipal Location:

Did we respond to your customer service needs?

Yes

Did we provide customer service in an accessible manner?

Yes

Do you have problems accessing our goods and services?

Yes

Additional Comments:

Contact Details

Please fill out the following information, if you would like a staff member to contact you regarding your feedback.

Your Name:

E-mail Address:

Home Phone:

Cell Phone:

Form Builder

Accessible Customer Service Feedback

Notice of Collection of Personal Information

Contact Details