2016/2017 Benchmarking Order Form Please complete this form if you wish to receive a copy of the 2016/2017 Local Government Customer Service Benchmarking Report. Please note there is no references to individual Councils or their data. The Report is distributed on receipt of payment. OK Question Title * 1. Please provide your contact information. Name Council City/Town Email Address OK Question Title * 2. How do you wish to pay for the report, which is $500 +GST? Credit Card (an additional 2.7% processing fee is applied) EFT OK Question Title * 3. Purchase Order Number OK Question Title * 4. Are you interested in participating in the 2017/2018 Benchmarking Program? Yes No Unsure OK DONE