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Water for Wildlife
Contact Details and Location - Part 1 of 2
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First Name
(Required.)
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Last Name
(Required.)
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Email Address
(Required.)
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Street Address (of applicant)
(Required.)
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Suburb (of applicant)
(Required.)
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State (of applicant)
(Required.)
Postcode
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Home phone number
(Required.)
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Mobile number
(Required.)
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Are you applying as an individual or as an organisation/business?
(Required.)
Individual
Organisation
If as an individual are you an Australian citizen OR a permanent resident?
Yes
No
If as an organisation/business, are you an Australian entity with a registered ABN?
Yes
No
Organisation Name (if applicable)
ABN if applicable:
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Do you agree to install the drinker(s) within 6 weeks of delivery and provide ongoing monitoring and maintenance (e.g. refill and clean)?
(Required.)
Yes
No
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You will be required to sign an ‘installation, maintenance and monitoring agreement’ if allocated drinkers. Please confirm you agree to sign this if your application is successful?
(Required.)
Yes
No
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Are you applying to receive drinkers for installation on private or public land?
(Required.)
Public
Private
Both
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What is the primary use of the property?
(Required.)
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Are you the owner of the property?
(Required.)
Yes
No
If No, please confirm in what capacity you are authorised to install and maintain the drinkers?
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How long have you lived there, or had authority over the property?
(Required.)
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Are you a landholder with an existing private land conservation agreement under the NSW Government Biodiversity Conservation Trust?
(Required.)
Yes
No
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Are you a landholder with an existing private land conservation agreement with an organisation other than the NSW Government e.g. Community Environment Network, Land for Wildlife program, Humane Society International?
(Required.)
Yes
No
If Yes, please confirm which one.
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What is the location of the property where the drinker(s) will be installed
(Required.)
Name of property (if applicable)
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Street (please do not list PO Box details, physical addresses are required)
(Required.)
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Suburb (of property)
(Required.)
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State (of property)
(Required.)
Postcode (of property)
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Would the preferred delivery address for drinkers be the same as the street address above?
The drinking station(s) will each be delivered as a minimum of 6 pieces. The largest piece is approximately 3 metres long and ~30kg.
(Required.)
Yes
No
