Water for Wildlife Contact Details and Location - Part 1 of 2 Question Title * First Name Question Title * Last Name Question Title * Email Address Question Title * Street Address (of applicant) Question Title * Suburb (of applicant) Question Title * State (of applicant) Question Title * Postcode Question Title * Home phone number Question Title * Mobile number Question Title * Are you applying as an individual or as an organisation/business? Individual Organisation Question Title * If as an individual are you an Australian citizen OR a permanent resident? Yes No Question Title * If as an organisation/business, are you an Australian entity with a registered ABN? Yes No Question Title * Organisation Name (if applicable) Question Title * ABN if applicable: Question Title * Do you agree to install the drinker(s) within 6 weeks of delivery and provide ongoing monitoring and maintenance (e.g. refill and clean)? Yes No Question Title * 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? Yes No Question Title * Are you applying to receive drinkers for installation on private or public land? Public Private Both Question Title * What is the primary use of the property? Question Title * Are you the owner of the property? Yes No If No, please confirm in what capacity you are authorised to install and maintain the drinkers? Question Title * How long have you lived there, or had authority over the property? Question Title * Are you a landholder with an existing private land conservation agreement under the NSW Government Biodiversity Conservation Trust? Yes No Question Title * 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? Yes No If Yes, please confirm which one. Question Title * What is the location of the property where the drinker(s) will be installed Question Title * Name of property (if applicable) Question Title * Street (please do not list PO Box details, physical addresses are required) Question Title * Suburb (of property) Question Title * State (of property) Question Title * Postcode (of property) Question Title * 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. Yes No Next
