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Kimberley Road Freight Request Form
Derby Chamber of Commerce is seeking input on the impact of the anticipated extended road closures on local business across the Shire of Derby West Kimberley. Many businesses are reliant on road freight to keep businesses alive. We understand that priority must be given to essential supplies such as food, medical supplies, fuel, gas, Health and hygiene products however we also believe that support is required to keep our local economy strong during this difficult period.
We ask that you take the time to complete the following which will provide us with valuable information that we can use to liaise and negotiate with Government to support local businesses.
BUSINESS DETAILS
Business Name
*
ABN
*
Physical Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Postal Address (if different to above)
Mobile Phone
Business Phone
Email Address
*
ROAD FREIGHT REQUIREMENTS
Average Monthly Road Freight (cubic metres m3)
Frequency of Deliveries
Point of Origin
FREIGHT UNABLE TO BE DELIVERED
NB: Vehicles can not be transported by barge. The more specific detail you can provide the better (eg: transport company, consignment No, locations etc)
List of items to be transported:
Description of Goods
Estimated Weight (Kg or g)
Size (m3)
Current Location
How long at current location
Transport Company Engaged
Dangerous Goods? If yes, describe risk in detail
1
2
3
4
5
Outline the risk to the business if freight cannot get to you.
Contact Name
*
First
Last
Date
DD
/
MM
/
YYYY
