Application for Rural Address
Applicant Name
*
First Name
Last Name
Rates Assessment Number
Address
*
Street Address
Street Address Line 2
City
State
Postcode
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email
*
example@example.com
Name of Owner
*
First Name
Last Name
Signature of Owner
*
Existing Property Name or Number
Road Name
*
Locality
*
LOT/DP
*
Section
Nearest crossroad
*
Related Development/Subdivision Application No. (If Applicable)
Have entrances been constructed?
*
Yes
No
Are there any identifying features to help locate your entrance?
*
How many lots need a new rural address number?
*
If replacement/s required, please specify number/s.
Postal Address - if required to post numbers out
Street Address
Street Address Line 2
City
State
Postcode
Please attach a map indicating where entrances are located
*
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Rural Addressing Number (new or replacement) Per Lot created
$150.60 AUD
$
150.60
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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