URGs - Formstack

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Utility Relief Grant Application Appointment

An appointment to complete a Utility Relief Grant application will take around 15 minutes to complete over the phone.

A successful application will depend on eligibility criteria - refer to this web link for more information:

https://services.dhhs.vic.gov.au/utility-relief-grant-scheme

Name*

First Name*

Last Name*

GV Water Property Address*

Address Line 1

City

Phone Number you would like us to call you on*

Please let us know when you would like to be called back to complete the application

Mark the days you are available for the draft*

Monday Tuesday Wednesday Thursday Friday

Availability for Monday*

9am-11am 2pm-4pm

Other: Other Value

Availability for Tuesday*

9am-11am 2pm-4pm

Other: Other Value

Availability for Wednesday*

9am-11am 2pm-4pm

Other: Other Value

Availability for Thursday*

9am-11am 2pm-4pm

Other: Other Value

Availability for Friday*

9am-11am 2pm-4pm

Other: Other Value

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