.

Online Form - Sign Up to E-Rates Form

Property Owner's Full Name*

Contact Number*

Postal Address

Postal Address:*

City:*

State:*

Post Code:*

Country:*

Property Address

Property Address:*

City:*

State:*

Post Code:*

Country:*

Email Address*

Property Assessment Number*

I agree to notify the Shire if the email address changes from the existing email address provided in this form.*

Yes

I understand that a hard (paper) copy will not be posted out to me.*

Yes

I confirm that I have read and accept the terms and conditions of the E-Rates service.*

Yes