Payment Arrangement Request

Payment Arrangement Request
We can discuss an appropriate payment arrangement plan that is better suited to your circumstances and in line with your income cycle, for example, weekly, fortnightly or monthly BPAY payments can be made to pay off your rates in smaller amounts.

If you would like to apply for a payment arrangement, please complete the form below. You can estimate your repayments based on your personal circumstances. Once submitted, your request will be reviewed and actioned by a rates officer within 14 days.

Note that payment due dates and penalty interest still apply per the rates notice terms and conditions until your request is approved.
The Shire of Augusta Margaret River collects your personal information to process this request and deliver Shire services. For details on how your information is managed, see our Collection Notices at www.amrshire.wa.gov.au/privacy/collection-notices.

This form is hosted by Jotform (US). By submitting, you acknowledge your information will be transferred outside Australia to a recipient subject to equivalent privacy protections.
Contact Details
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Property address
Assessment number (if known)
See the example rates notice below in order to locate your assessment number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Arrangement Calculator
Repayment Schedule
Outstanding Balance
Weekly Repayment Start Date
Estimated Weekly Interest Per Payment
Estimated Weekly Repayment Amount
Fortnightly Repayment Start Date
Estimated Fortnightly Interest Per Payment
Estimated Fortnightly Repayment Amount
Monthly Repayment Start Date
Estimated Monthly Interest Per Payment
Estimated Monthly Repayment Amount
Proposed Repayment Amount
Minimum Number of Payments Required
Proposed Frequency
Days to Complete Payment
Current Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cut Off Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated Date for Final Payment
Total Interest
If the payment arrangement date has exceeded 8th April 2027, an application for Financial Hardship will need to be submitted in order to avoid debt recovery commencing.
Payment Arrangement Conditions
Payment is due as shown on the rate notice until a payment arrangement has been approved.

Please note that a payment arrangement is not automatically accepted upon submission of this request form. Your request will be reviewed by a rates officer within 14 days.

The payment arrangements will be calculated to start within 14 days from the date of application to the due date of the final instalment.

Interest applies on approved payment arrangements and is charged at the rate of 4.49% as adopted by Council. Eligible pensioners and seniors are exempt from instalment interest.

Default on the agreed payment arrangement may result in the referral of the debt to the Shire’s debt recovery agency without further notice to you.
Signature
Should be Empty:

Payment Arrangement Request

Contact Details

Property address

Payment Arrangement Calculator

Payment Arrangement Conditions