Online Form - Bin Request Application

This form must be completed by the owner of the property, or an authorised party (i.e. Real Estate Agent) only.

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You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Email Address:

Password:

There is no way to resend or recover your password, please write it down.

Note: Incomplete forms are kept for a period of 2 day(s) , after this time the system will automatically delete your response.

Applicant Name / Company Name *

Is the applicant the property owner or the property owners' authorised person/company?

YesNo

Is the Owner Name as above? *

YesNo

Is the Occupier Name as above? *

YesNo

Property Address

Street Address:

City:

State:

Post Code:

Country:

Contact Number *

Email *

Lot Number (if known)

Assessment Number (if known)

How many Rubbish Bins are currently kept at the property? *

How many Rubbish Bins will be kept at the property following this request?* *

How many times a week do the rubbish bin/s get collected (emptied)? *

How many times a week would you like your rubbish bin/s to be collected following this request?* *

If more than one collection per week, will all bins be emptied at each collection?

YesNo

Does the Bin Require Repairs * *

New Bin - please select the option that best describes your situation *

New Bin Sticker *

MondayTuesdayWednesdayThursdayFridayNo Sticker Required

Please Provide Reason for Requiring New Sticker *

*Please see the Shires current Fees and Charges.

Please type your name below to signify that you agree that all information given above is true and correct at the time of submission *

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