Application Form
Bulk Water Purchase from Depot
(Drought Declared Area)
Postal Address
LMB 7
Inglewood QLD 4387
Engineering Services
Ph: 07 4671 7449
Fax: 07 4671 7433
Internet/Email
www.goondiwindirc.qld.gov.au
[email protected]
Applicants shall make themselves familiar with Council’s Cost Recovery Fees & Commercial Charges; and Supply of Domestic Water to Drought Declared Area
Policy which are available by contacting Goondiwindi Regional Council or on Council’s website at www.goondiwindirc.qld.gov.au
Applicants Details:
Company Name (if applicable):
Mr
Mrs
Ms
Miss
Given Name/s:
Surname:
Postal address:
Email:
Mobile Phone:
Work/Business Phone:
Purchase Details:
Depot Location:
Goondiwindi Depot
Inglewood Depot
Date of Purchase:
Texas (24 hour notice required)
Expiry Date:
Total Quantity of Water
Required:
Number of Truckloads Required to
collect total quantity of water:
KL
(maximum 30KL/3 Months)
TRUCKLOADS
(minimum 1 KL/Load)
(3 months from date of purchase)
Unit Rate:
$1.24/KL
=
$
Unit Rate:
EXEMPT
=
$EXEMPT
TOTAL COST:
$
Applicants Consent:
I/We hereby request that Goondiwindi Regional Council supply the quantity of water from the depot specified in this form and that
I/We have read, understand and consent that:
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This application is made under the provisions of Council’s Supply of Domestic Water to Drought Declared Area Policy;
I reside within a drought declared area within the Goondiwindi Regional Council area;
The maximum quantity of water is 30,000L (30KL) on a 3 monthly basis per residential dwelling;
The minimum load per collection is 1,000L (1KL);
The total quantity of water required must be collected within 3 months from the date of purchase;
The water is to be used for domestic purposes only; and
Water collected by a non-register water carrier shall be deemed as non-potable water.
Signature of Applicant:
Date:
Office Use Only:
Fee:
$
COMMENTS:
Date:
Receipt #:
Name: