KERBSIDE SERVICE - APPLICATION FORM
                                                  REFUSE and RECYCLE WHEELIE BINS
 CHARGES P/A: REFUSE 140L = $46.70, 240L = $80.10                            RECYCLING 140L = $52.80, 240L = $86.10

                    Address:                                                                             Phone:
Applicant Details
   Section 1

                    Contact Name:                                                                        Mobile

                    Business Name (if applicable):                                                       Fax

                    Please indicate your Application Type:          NEW        UPGRADE           DOWNGRADE               REMOVAL

                    CRITERIA FOR 240L BIN: Families consisting of Five (5) or more permanent residents in a household may apply for a 240L Bin
                        for refuse Medicare Card to be sighted. Upgrade recycling services available for all households. Section 4 must be completed.
                                                                                                                              REFUSE             RECYCLING
Service Type
  Section 2

                                                                                                                         140L         240L       140L        240L
                    NEW SERVICE (Council Standard Service is 140L)

                    UPGRADE / DOWNGRADE


                                                                                                                          Business                Private
                    Please indicate the type of PROPERTY this Wheelie Bin Application is for                              Activities             Household
Property Details
   Section 3

                    Are you the OWNER of the property for which this application pertains?                                      Yes                     No

                    If you are moving into new premises, has the FINAL BUILDING INSPECTION or
                                                                                                                                Yes                     No
                    OCCUPANCY PERMIT/CERTIFICATE been completed?

                                                    240Litre Applicants Only (Excluding Commercial Applicants)

                    Number of ADULTS permanently residing in household
Upgrade details

                    Number of CHILDREN permanently residing in household
  Section 4

                    Other reasons a 240L bin may be required:

                    MEDICARE CARD sighted - Office use only                                                                     Yes                     No

                                                                              Signature of Applicant

                                                                                                  Date                    /                  /

                                                                 Please Note This Important Information
                    Council advises that all residential households will be charged a Waste Management, Recycling, and Green Waste Rate, including

                    those residents who choose to have any or all of these services removed from their property.

                    Council's services will not accept toxic or hazardous wastes, commercial food wastes, or materials which may damage bins or the
                    collection vehicles.
                    By signing this form you undertake to notify Council of any change to the facts stated within this form.

                    Properties used for Business Activities or in excess of standard service attract a 10% Goods and Services Tax (GST).
                                                    OFFICE USE ONLY

APPLICATION:          Approved / Not Approved
                                                                                            Waste Management Co-ordinator

NOTIFICATION                                                                                         DATE

Veolia Environmental Services Faxed /Emailed                                                                          YES             NO             N/A

Letter sent to property owner (refer Section 3)                                                                       YES             NO             N/A

Finance Program                                                                                                       YES             NO             N/A

TECH-ONE updated                                                                                                      YES             NO             N/A

Final Building inspection or occupancy Cert Completed                                                                 YES             NO             N/A

Date Delivered                                                                                                        YES             NO             N/A

     All zeros before a bin number are excluded from the actual bin number, for example bin number
     000025 is in fact number 25.

     240L Wheelie Bins have the prefix 240 before the rest of the bin number, for example a 240 litre
     the number 000356 becomes 240356

                                Personal Information Protection Statement

     The personal information that Council is collecting from you is deemed personal information for
     the purposes of the Personal Information Protection Act 2004.

     The intended recipients of personal information collected by Glenorchy City Council may be:
     Officers within Glenorchy City Council;
     Data service providers engaged by Council from time to time;
     Any other agent/contractor of Glenorchy City Council.
     The supply of the information by you is voluntary. If you cannot provide or do not wish to
     provide the information sought, Glenorchy City Council may be unable to process your
     application or request.

     Council is collecting this personal information from you for the purposes of managing, assessing,
     advising upon and determining the relevant application, or other Council related matters.

     You may make application for access or amendment to your personal information held by
     Enquiries concerning this matter can be addressed to Freedom of Information Officer,
     Glenorchy City Council, PO Box 103, Glenorchy, 7010 Phone: 6216 6700

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