Private Bag 9023 | Whangarei 0148 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: mailroom@wdc.govt.nz
09/37603 January 2013
Monthly Building Consent Register Application Form
Name/Company
Contact no
Postal address
Email address
(See current Schedule of Fees and Charges for application fee)
Please indicate your subscription (
one)
Subscription for
months from
to
Annual subscription
from
to
Subscription to be cancelled
Please indicate method of correspondence
Please email
Please post
Name (please print)
Signature
Date
Comments
Payment options (
one)
Eftpos/cash
Cheque
Visa
Master card
Credit card details
Card number
Card expiry date
/
Cardholder’s name
Office use
Receipt to: GL mneumonic BCregister
Receipt no
Amount paid
Cashier’s signature
Date
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