Online Form - Application Form - Old Perth Road Markets Equipment and Minor Capital Projects Fund

Describe what form is for

Project name

Please enter a project name e.g. Purchase of Xxxx, Upgrade to Xxxx

Name of applicant group *

Type of applicant group *

(If 'Other' selected, please specify type of applicant group)

Address *

Postal address

Name of contact person (must be over 18 years of age) *

Position of contact person *

Best daytime contact number

must be over 18 years of age

Does the applicant group have an Australian Business Number (ABN)?

YesNo

Is the applicant group incorporated?

YesNo

Does the applicant group have current public liability insurance? *

YesNo

If the applicant group has current public liability insurance, please attach a copy of your certificate of currency for public liability cover *

Brief background of organisation (purpose, how long in operation etc. - 150 words maximum) *

Project description (brief descripton of overall project - 150 words maximum) *

Project outcomes *

What benefits do you see for your group from this project? *

Target group - Who is the project being developed for and approximately how many people will benefit from this project? *

What relationship does your organisation have with other services within the community *

Type the code from the image