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Wheelie Bin Application Form – Domestic or Commercial Form No E6401-501 Lockyer Valley Regional Council, PO Box 82, Gatton Qld 4343 Version 1.0 Phone: 1300 005 872 Email: [email protected] Page 1 of 1 Wheelie Bin Application Form Domestic Commercial New Service Additional Cancellation Applicant Details Title Surname Given Names Company Name Postal Address Suburb State Postcode Home Phone Work Phone Mobile Fax Email Address Property Details Property Owner/s Property Address Suburb State Postcode Lot Plan Property ID Is there a letter box at the property? Yes No Bin Details Type of Service Current Current No. of Bins/Sets Attend Per Week/FtNt New New No. of Bins/Sets Attend Per Week/FtNt 240L Dual Set – 1 Waste + 1 Recycle 240L Additional Waste Only 240L Additional Recycle Only Delivery Details Date to be delivered Next Service Day ASAP Name of Owner / Authorised Representative Signature of Owner / Authorised Representative Privacy Statement These details will only be used for the purpose for which they have been collected and will not be used for any other purpose. We will not disclose the information you provide outside of Council unless we are required by law or you have given your consent. To the fullest extent allowed by law, Council, its officers and employees will not be liable for any claims in respect of any loss arising out of, or in connection with, the use of any of the supplied information.
