Extension of Time/Payment Plan for Land Clearance Invoice

PRIVACY NOTE: The personal information requested in this form is being collected by Council for payment assessment for an Invoice. The personal information will be used solely by Council for that primary purpose or directly related purposes. The applicant understands that the personal information provided is for payment assessment for an Invoice and they may apply to Council for access to and/or amendment of the information.

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Invoice Details

Invoice Number(s): LLLC

Invoice Amounts $

Property Address:

Applicant's Details (The applicant must be the owner listed on the invoice)

Given Name

Family/Surname

Preferred Contact Number Type

Home

Work

Mobile

Preferred Contact Number

Email Address

Address

Street No and Street

Suburb

Postcode

Payment Options

Payment Options (Select One)

Extention of Time (An extended period in which to pay the Land Clearance invoice in full)

Instalment Payment Plan (Part payment made over a 6 month period)

Additional time requested to pay invoice

1 month

2 months

3 months

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