Customer Request Management Entry

Instructions

Please complete all relevant sections of the form

Please note:
Changing your email address with Council will update all Council email contacts including Rates and Water Notices via email.
Only one email address can be held for the owner of single or multiple properties.

Application to Register My Dog

Customer Contact Details *

Customer

Name

Code

Surname *

Given Name * / Second Name

Contact Details

Postal address

Street address line 1 *

Street address line 2*

Street address line 3

Postcode *

Postal address if different from residential

Street address line 1 *

Street address line 2*

Street address line 3

Postcode *

Work phone

Home phone

Mobile phone

Email address *

Alternate phone

What is your preferred method of contact?

Not required

Telephone

Description (e.g. 'Register my dog')

Enter a brief description of your request

Property Address *

Enter some or all of the property details below. If searching by street name, enter the street name only (e.g. Spence); do not include the street type or suffix (e.g. St, Road, Ave etc). Alternatively you can search by Lot or RP number. Then click the Search button to proceed to the property results screen where you can confirm the address.

Building Name

Unit No.

Level No.

House No.

Street Name

Suburb

Title Type

Title 1

Title 2

Title 3

Title 4

Title 5

Title 6

Is your dog kept at the Property Address listed above? If yes, please leave the following 3 address fields blank. If no, please complete the 3 address fields.

Yes

Kept at street number / name

Kept at suburb

Kept at postcode

Registration type (Required)

Dog name (Required)

Primary breed (Required)

Secondary breed (if a cross breed)

Any distinguishing features?

Primary colour (Required)

Secondary colour

Sex (Required)

Dog's date of birth (DD/MM/YYYY) (Required)

Regulated dogs only

Does your dog have a microchip? (Required)

Yes

PID / Microchip Number

Desexed (Required)

Yes

Level 3 obedience dog *

Yes

Pensioner (Health Care Cards are not accepted) (Required)

Pension Card No. (Only Blue Centrelink Pension Cards and Gold Veteran Affairs cards accepted)

Have you selected Yes to any of the above, or filled in a pension card number? If yes, please scroll up to attach the relevant documentation. If no, please continue and Submit your application. (Required)

Yes

Attach relevant documentation here

Browse for an attachment to link to this application

Please re-confirm your email address for payment purposes (Required)

Do you wish to receive your renewal notice via email?

Yes

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