Application for Skip Bin Licence Privacy Statement The Town is collecting your personal information for the purpose of responding to your request. Some of the information may be provided to the Town's contractors for the purpose of addressing your request. Your information will not be provided to any other person or agency unless you have given us permission, or where legally obligated to do so. If you would like to know more about how the Town handles your personal information, please see the Town's Privacy Statement and Collection Notice. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Any skip bins that are to be placed on Town of East Fremantle land (i.e verge areas and/or carriageways) must be approved before they are delivered. A skip bin approval will be issued at a cost as per the Town's Schedule of Fees and Charges. Should you require the bin for longer than one week, you will need to re-apply for an extension of the licence. Please note there is a cost as per the Town's Schedule of Fees and Charges. Once your application has been assessed, you will be contacted and notified of the outcome and request for payment. Name*This field is required. * Required Field. Company Name (If Applicable) Residential / Business Address - Address where skip bin is to be placed if approved*This field is required. * Required Field. Phone Number Mobile Phone Number*This field is required. * Required Field.* PLease enter a valid mobile phone number Email Address*This field is required. * Required Field.* Please enter a valid email address Size of Skip Bin (Cubic Metre)*This field is required. * Required Field. Date bin is to be delivered*This field is required. * Required Field. Date bin is to be collected*This field is required. * Required Field. If you have a photograph of the area where the skip bin is to be placed, please attach it here Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx Location RoadVerge Signature * Required Field. Date Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image