Customer Service Request First Name * Last Name * Street Address * Town/City * Province * Postal Code Phone Number * Email * Customer Follow-up Required * Would you like someone from the Village of Pemberton to contact you regarding this request? Yes No Nature of Request * Photo (if applicable) Choose File No file chosen The maximum total size of all files in a single form submission is 1 GB. Freedom of Information Personal information you provide on this form is collected pursuant to section 26 of the Freedom of Information and Protection of Privacy Act and will only be used for the purpose of processing the business licence application. Your personal information will not be released except in accordance with the Freedom of Information and Protection of Privacy Act. Questions about the collection of your personal information may be referred to Sheena Fraser, Manager of Corporate and Legislative Services (sfraser@pemberton.ca or 604-894-6135). Leave Blank