WaterSmart Business Grant Application Form

Business Name *

ABN *

Postal address *

Contact name *

Position *

Telephone *

Mobile *

Email address *

Does the business have a current Water Management Plan? *

Yes
No

If yes, please attach a copy

Project name *

Site address (where the project will be located) *

Type of project (check all that apply) *

Substitution of mains drinking water
Rainwater
Surface/Stormwater
Groundwater
Wastewater recycling
Water efficiency measures

Proposed commencement date *

Day Month Year

Proposed completion date *

Day Month Year

Have you completed other water saving projects previously? *

Yes
No

If yes, please describe *

If relevent, include consultant reports, results of feasibility studies and results from consumption monitoring. *

Have all permits/licences been obtained? *

Yes
No

If yes, provide details

Have you consulted with a technical expert about the project? *

Yes
No

If yes, provide details

Total estimated cost of project *

Funding amount requested *

Detail any additional sources of funding which have been confirmed, or will be sought for this project

Detail any in-kind support provided for this project i.e. discounts, reduced labour costs, volunteer assistance etc.

Payback period of the project = Cost of project / water savings ($) * Example: Total project cost $10,000 and annual water savings $1,500, the payback period is 6.7 years

Expected town/potable water savings (kilolitres / year) *

Expected sewer discharge or trade waste volume savings (kilolitres / year) *

Outline any expected energy savings or increase in energy use *

Explain how the project will benefit the environment and the community *

Attach letters of support from local groups if applicable

Explain how the results of the project will be communicated, e.g. company newsletters, local newspapers, website etc. If applicable attach marketing plan, and educational/promotional opportunities *

marketing plan, educational/promotional opportunities

Supporting documentation

Name *

Position *

Date *

Day Month Year

Water and waste

WaterSmart Business Grant Application Form

Applicant information

Project information

Provide details of the proposed project, including objectives and proposed timeline

Project costs

Environmental and community benefits

Communication materials

Further Supporting Documentation

Declaration

Privacy Statement

Water and waste

WaterSmart Business Grant Application Form

Applicant information

Project information

Provide details of the proposed project, including objectives and proposed timeline

Project costs

Environmental and community benefits

Communication materials

Further Supporting Documentation

Declaration

Privacy Statement

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