Homeless Services in the Inner City Brochure Order Form

Please note: if there is more than one department in your organisation, please use this form to submit a central order.

1. Customer Details

First Name:

Surname:

Address

State:

Postcode

Telephone (home):

Telephone (business):

Mobile:

Facsimile:

Email:

2. Purpose / Use of Brochure

Please indicate your intended use of the brochure (i.e. case management, outreach, staff resource, etc.)

3. DL size brochures

Please indicate quantity required:

Individual DL size brochures

or

Box of DL size brochures (contains 240 copies)

4. Z-Cards

Please indicate quantity required:

Individual Z-Cards

or

Box of Z-Cards (contains 300 copies)

5. Customer Authorisation

Signature (Please type your full name)

Please be advised that orders over 40 brochures are required to be collected from Council House (27 St Georges Terrace, Perth).

Privacy - The personal information collected on this form will only be used by the City of Perth for the sole purpose of providing requested and related services. Information will be stored securely by the City of Perth and will not be disclosed to any third parties without your express written consent.

Copyright - I authorise the City of Perth to reproduce any attachments provided with this form for internal purposes only.

Need more help?

If you have any questions, please contact Community Services on : (08) 9461 3392 or email: cmsinbox@cityofperth.wa.gov.au

Residents

Businesses

Building and Planning

Community

Council

Homeless Services in the Inner City Brochure Order Form

1. Customer Details

2. Purpose / Use of Brochure

3. DL size brochures

or

4. Z-Cards

or

5. Customer Authorisation

Need more help?

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