<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Sample Form

Report a Long Term Vacant or Derelict Property?


Title:
First Name:
Last Name:
Address:
Postcode:
Tel No:
Email:
Confirm Email:
Mobile:
Property Details
Address of the property concerned: (if you do not know the correct address please provide as much information as possible)
Postcode:
Type of property:
Property Owner (Name and address of the person or the orginisation that owns the property, if you know it)
How is the property affecting you? (e.g. eyesore to neighbourhood, garden full of rubbish, used by local children as a playground, derelict)
How long has the property been vacant?