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Repair or Replacement of Residential Bin Request Form

Use the below form to request a repair or replacement of Residential bin. Please note fields marked with an asterisk (*) are required:

Applicant Details

Date Requested *

Day

Month

Year

First Name *

Surname *

Phone *

Email *

Person making request *

Property Details where bin is located

Street/Lot Number *

Street Name *

Locality *

Assessment No.

Town/Regional *

Town

Regional

Bin Size & Type *

Repair or Replacement *

Repair

Axle

Wheel

Lid

Pins

Reason for Replacement

Notes/Comments *