Application for Skip Bin Service

Applicant Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Property Address*

Street Address

Street Address Line 2

CityState

Postcode

LOT/DP

Billing Address is the same as property address*

YesNo

Billing Address

Street Address

Street Address Line 2

CityState

Postcode

Required Bin Service(s)*

Cardboard CollectionWaste Collection

Cardboard Collection

To be eligible for this service a minimum collection of once a month per bin is required.

Cardboard collection charges are billed monthly.

No payment is required with this application.

Please see fees and charges for cost per collection.

Number and Frequency of Service

	Number of Services	Frequency of Service
240 Litre Bin
660 Litre Bin
1100 Litre Bin

Waste Collection

To be eligible for this service a minimum collection of once a month per bin is required.

Waste collection charges are billed monthly.

No payment is required with this application.

Please see fees and charges for cost per collection.

Number and Frequency of Service

	Number of Services	Frequency of Service
240 Litre Bin
660 Litre Bin
1100 Litre Bin

Application Declaration

I hereby agree to pay Council for the above service(s). I understand an account will be sent each month and forwarded to the email address I have supplied.
I acknowledge that charges may increase annually and will be published on Council's website under Fees and Charges.
I acknowledge that I must advise Council in writing of changes to service at least 7 days prior to collection date.
I acknowledge that I must complete the Cancellation - Skip Bin Service Form to cancel this service at least 7 days prior to collection date.
I acknowledge that the service(s) will be cancelled and the bin(s) will be removed if my account is unpaid for 3 months or more.

Signature*

Date*

Date

Purpose of Collection:	For applying for waste and recycling services.
Intended recipients:	Council staff and approved contractors of Council.
Supply:	Voluntary. If you do not provide all details requested, Council may be unable to, or limited in its ability to supply the requested services.
Access/Correction:	Contact Council Customer Service Team on (02)6226 1477 to access or correct this information.
Storage:	Contact Council Customer Service Team on (02)6226 1477 to access or correct this information.

Privacy and Personal Information Protection Act 1998

Compliance with Section 10

This information is required to ensure that Council can communicate with you in relation to the supply of waste services. The information is private and confidential and Council must not disclose the information to any person or body if it is not directly related to the purpose for which the information was collected.

If you have a complaint about the use of your personal information, contact the Yass Valley Council Public Officer. The information contained or referred to in this form may be corrected and updated by you, by contacting the Council.

Privacy Statement

You will need to provide personal information to Yass Valley Council in respect of this application. Council is required under the Privacy & Personal Information Protection Act 1998 (PPIPA) to collect, maintain & use your personal Information in accordance with the Privacy Principles & other relevant Requirements of the PPIPA.