WHC Repairs Request Form

Contact Details:

First Name: *

Last Name: *

Email Address: *

Contact number: *

Address Details:

Street address: *

City: *

State: *

Postcode: *

Repair Details

Is this a new request?: *

YesNo

Would you like an interpreter when we contact you?: *

YesNo

Other (please specify): *

Please provide information about your request: *

Image Upload

Images are optional: If you can take photos of the issue and upload images, our team will be better able to work out the best response.
All images must be in jpg pdf and png format and uploaded using the below section.
Please check the images are displayed clearly.
Images must be no larger than 2MB.

Image 1 Upload:

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Image Upload 2:

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Image Upload 3:

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The Women’s Housing Company collects personal information about you in order to make it easier to provide you with the assistance you are entitled to. Please refer the Women’s Housing Company Privacy Policy for further details.