REQUEST FOR ORDERS & REQUISITIONS
(REAL ESTATE AGENT)
1. Property Details
Property Street address
Lot Number
PO Box or street address
Suburb
State
Postcode
2. Disclaimer
The information provided in the Orders and Requisitions is made in good faith only. The information provided above
is based on the City’s records and is not the result of a site visit or audit of the property. The City of KalgoorlieBoulder and its employees are not liable for any person’s damage or loss which may occur as a consequence of
action (or inaction) arising from the use of this information.
3. Owner Details
Owner’s name
I have read the above Disclaimer and request Orders and Requisitions for the above property. I give
authorisation to the Real Estate Agent (below) to request Orders and Requisitions on my behalf.
Declaration
Date
Signature
4. Real Estate Agent
Company Name
Email Address
I have read the above Disclaimer and have authorisation from the owner to make this application.
Declaration
Date
Signature
Please note that this is a service provided free of charge by the City of Kalgoorlie-Boulder.
Office Use Only
Lot Number:
___________
Assessment Number:
A__________
Officer:
________