What is the issue? (Please be as specific as possible and where possible provide evidence) *

(If you are reporting a speeding issue please identify the exact location where you require the metro count strips to be laid ie. lamp post column number(s), road sign(s), and house number(s)) and the name and number of the road.)

Where is the issue happening? *

Royal Wootton Bassett and CrickladeAmesbury Bradford on Avon Calne Chippenham Corsham Devizes Malmesbury Marlborough Melksham Pewsey Salisbury South West Wiltshire Southern Wiltshire Tidworth Trowbridge Warminster Westbury Royal Wootton Bassett and Cricklade

Street / Location? *

How long has it been an issue? *

Who is affected by this issue? *

What have you / your organisation done to try to solve the issue? *

What would you / your organisation like to see done to resolve the issue? *

Which organisations, service providers and / or community groups do you believe need to come together to sort it out?

Have you been in touch with your Councillor? *

Yes No

First Name *

Last name *

Organisation if applicable

I am

a Business a Community Group a Parish Council a Service Provider a Member of Public a Community Area Partnership a Unitary Councillor a Neighbourhood Policing Team other

Email *

Telephone (full std code and number, eg 01225 713000) *

Address:

House Name or Number:

Street Name:

Town:

County:

Post Code: