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Porcupine

Community Feedback/Comment Form

Thank you for your feedback. The more information you provide, including your contact details, the more efficiently PGM will be able to follow up. If you prefer, you can submit your feedback anonymously. Please fill out the sections highlighted on the form below. If you are uncertain regarding some of the questions, the PGM Communications Coordinator can assist you.



Details of Feedback/Comment

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Contact Information

Is this an urgent request that requires immediate attention?

First Name: Last Name: E-mail: Postal Code: What site is this in reference to?
Note: You can also request that the company not disclose your identity to a third party (contractor or others) without your consent.
I request not to disclose my identity without my consent.
I authorize the involvement of third parties (contractors or others) to help resolve the issue.

Additional Contact Information

Address: City: Country:
Province:
Telephone: Please contact me:

Preferred Language of Communication

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Feedback/Comment

Type of Feedback/Comment:
Related to:







Other: Please Specify
Incident Date: Time: Hours Minutes Details of feedback or comment, positive observation, or concern:  
What happened? When did it happen - time and date? Where did it happen? Who did it happen to? What is the result or impact of the problem?
What would you like to see happen to resolve the problem?