Dog Issues - Customer Service Request Form Name * Address * Phone Number * Email * Date of Occurrence * Time of Occurrence * Location of Occurrence * Details of Occurrence Details of Dog/Dog Owner Name of Dog(s) Dog Tag Number(s) Age of Dog Breed/Colour Owner Name Owner Address Owner Phone For Office Use Only Received By Referred to CC Notes Date of Follow Up 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 Corporate and Legislative Services (corporate@pemberton.ca or 604-894-6135). Leave Blank