(New premises)
Add: 48 Longueville Rd, Lane Cove Post: PO Box 20 Lane Cove 1595
Tel: (02) 9911 3555 Fax: (02) 9911 3600 Web : lanecove.nsw.gov.au Eml: lccouncil@lanecove.nsw.gov.au
Applicant
( to be completed by applicant)
Bin Request
Details
Conditions of
Consent
Declaration by
Applicant
Name of Property Owner or Mana ging Agent: …………………………………………….
Rates Assessment Number: ………………......
Property a ddress: ……………………………………………………………………………
Business name (if applicable ): ……………………………………………………………..
Delivery address: ……………………………………………………………………………...
Contact No: ……………………………… Mobile: …………..……………….
Date bin/s required: …………………………
Type of Service Requested No. of
Services
Cost of
Service /yr
$399
Total
Cost
1X80L Garbage + 2X120L Recycling
( Residential Properties )
1x80L Garbage (each) +2x240L
Recycling (per 10 units)*
(Multi Unit Dwelling)
1X80L Garbage + 2X120L Recycling
(Business only)**
1X80 L Garbage + 2X120L Recycling
(Non – Rateable properties)
$399*
$399
$399
Total Cost of Bins
1. All applications must be accompanied by an up front payment (Pro-Rata) for the remainder of the rating year in which the application is made & thereafter the cost of this service will be added to the rate assessment notice.
2. Council may withdraw the additional service if the rates account falls into arrears.
3. Council may withdraw the additional bin service if bins are continually contaminated with non-collectable waste.
4. The bins will be delivered within one week from receipt of request.
5. Council requires two weeks written notice for cancellation of this service.
6. * Council will provide the equivalent of 1x240L General waste bin for every 3 units. The charge of $399 is inclusive of all waste services and applies to each unit
7. ** Applies to residential premises within commercially zoned properties. E.g.
Upstairs flat
I understand and accept the Conditions of Consent and that I am the “Authorized” person to execute the request for additional waste bin service.
………………………………………………. …………………….
Signature of Property Owner Date
Payment form over 1 of 2

Fees are based on financial Year 2014/2015
TRIM NO. 21403/08

Privacy
Cardholder Details
Card Details
(We DO NOT accept Amex or
Diners Club Cards)
Office Use Only
(T1+ Rates
Assessment
Number)
Under the Privacy or Personal Information Protection Act (PPIPA), Council is required to advise you that personal information being collected from you in relation to this matter will only be used for the lawful and proper functions of Council. Any such use will be in accordance with this Act and its associated Management Plan and Codes.
Name on Card: ………………………………………………………………………
Address
(if different from above
): ……………………..……………………………
Suburb (if different from above) : ……………… Postcode:…………..
Contact Numbers ( if different from above ):
 MasterCard  VISA
Card No:
   
Expiry date:  /  Payment Amount:
………………………………………………… ………………………….…..
Cardholder Signature Date

Please note that this payment is subject to approval of funds by your financial institution.

A 1% fee (incl.GST) is applicable to all credit card payments
Number of Bins Allocated
80 L General Waste
2X 120L Recycle Bins (Blue +
Yellow)
Total no of bins
No. of Bin
Approved
URM notified
Yes No
Processed Date: Completed by
Comments if disapproved:
2 of 2

Fees are based on financial Year 2013/2014
TRIM NO. 21403/08