APPLICATION FOR WASTE AND RECYCLING BINS (RESIDENTIAL PROPERTIES ONLY)

Owner name:___________________________ Property address: _________________________________

Contact: (Hm) _________________ (Mob) _________________ (E-Mail) ____________________________

Do you wish to update your postal address for City correspondence, including rate notices?

NO YES and the new postal address: __________________________________________________

I _________________________ (name) am the property owner, the property was/will be occupied on

the ________________ (date) and I request the provision of:

Bin Options (maximum of 1 waste & 1 recycling) Unit Price

240 litre waste bin

240 litre recycling bin

360 litre recycling bin

= $87.50 (GST inc)

= $87.50 (GST inc)

= $120.50 (GST inc)

Signature:______________________________ Date:________________

Please note:

Payments can be made by cheque (made payable to 'City of Fremantle') and posted to POBox 807, Fremantle WA 6959 or in person at the Customer Service Centre, 70 Parry Street,Fremantle.

Credit card payments can also be accepted by completing the required details above.

All credit card payments incur a 0.5% transaction fee. American Express is not accepted.

Internal use onlyCashier code - (240lt Bins) Cashier code - (240lt &360lt Bin)

Receipt Number:

Property address

Waste Management date delivered

Waste Management bin numbers

Last modified July 2018

Credit Card Details Mastercard Visa

Card number: Expiry: /

Name on card: Amount: ____________ (Inc. GST)

Signature:

I acknowledge that the bin costs are payable prior to delivery and that this delivery will only occur where the property is occupied.