Contact Details and Location - Part 1 of 2

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* First Name

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* Last Name

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* Email Address

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* Street Address (of applicant)

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* Suburb (of applicant)

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* State (of applicant)

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* Home phone number

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* Mobile number

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* Are you applying as an individual or as an organisation/business?

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* If as an individual are you an Australian citizen OR a permanent resident?

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* If as an organisation/business, are you an Australian entity with a registered ABN?

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* Organisation Name (if applicable)

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* 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)?

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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?

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* Are you applying to receive drinkers for installation on private or public land?

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* What is the primary use of the property?

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* Are you the owner of the property?

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* How long have you lived there, or had authority over the property?

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* Are you a landholder with an existing private land conservation agreement under the NSW Government Biodiversity Conservation Trust?

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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?

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