E008 - Equipment Loan Agreement Applicant Details Organisation/Business Name*This field is required. * Required Field. Contact Person*This field is required. * Required Field. Address*This field is required. * Required Field. Telephone Number*This field is required. * Required Field. Alternate Contact Number Email Address*This field is required. * Required Field.* Please enter a valid email address. Agreement Details This agreement is made on the:*This field is required. * Required Field. between the City of Greater Geraldton and I,*This field is required. * Required Field. on behalf of*This field is required. * Required Field. Agree to return the equipment in good condition to the City of Greater Geraldton by,*This field is required. * Required Field. I understand that failure to return the equipment by the agreed date will incur the full replacement cost, and any damages or loss will incur full replacement cost of said damages or loss. Please Note Replacement Flags cost approximately $150.00 each and the replacement flag stand cost between $150.00 and $200.00 each. Equipment Hired Item 1 & Quantity Item 2 & Quantity Item 3 & Quantity Item 4 & Quantity Item 5 & Quantity I accept full responsibility of the borrowed equipment and the replacement cost in the fail to return them by the agreed date? YesNo I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application.*This field is required. Please tick here Signature*This field is required. * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Equipment Loan Agreement form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at privacy@cgg.wa.gov.au. Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.