Online Form - Graffiti Removal Pack Application

Complete this form to apply for a Graffiti Removal Pack.

Applications will not be processed until graffiti incidents have been reported through the Goodbye Graffiti website https://www.goodbyegraffiti.wa.gov.au/, Crime Stoppers WA or directly to WA Police.
An Incident Report Number from 'Goodbye Graffiti' website, Crime Stoppers WA or directly to WA Police is required.
Photos of the graffiti are required with this application.
Graffiti Removal Pack is available whilst stocks last.
Applicants will be contacted on approval to organise a collection from 20 Coolibah Drive Kununurra 6743.

Applicant, Graffiti and Property Information

Full Name*

Business / Organisation (If applicable)

Street Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Mobile Number*

Email*

Comments

Have you previously received graffiti removal pack?

YesNo

Please attach Photos

Max File Size: 100.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Who did you report the graffiti to?*

WA Police ForceGoodbye GraffitiCrime Stoppers WAI haven't reported it yet

Please insert Incident Report Number:*

Snap Send Solve Reference (If Applicable)

I acknowledge that the Shire of Wyndham East Kimberley does not accept any liability for injuries or accidents that may occur during graffiti removal activities.*

Yes

I agree that responsibility for handling chemicals, tools, and personal safety during graffiti removal lies solely with the individuals carrying out the task.*

Yes

Please print your name below to acknowledge the above*

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