Gunnedah Home Hosting - Ag Quip Accommodation

Gunnedah Home Hosting
FREE CALL 1800 KOALAS
(1800 562 527)
info@gunnedahhomehosting.com.au

Gunnedah Visitor
Information Centre
Anzac Park, South Street, Gunnedah
T 02 67402230 | F 02 67402237
www.infogunnedah.com.au

2012 Home Hosting Registration Form

SECTION 1 | CONTACT DETAILS
Please check / indicate your correct details below | * denotes required field

Name:	*
Address:
Telephone:	*
Fax:
Mobile:
Email:	*

SECTION 2 | PARTICIPATION
I am willing to accommodate guests for

AgQuip Field Days (21 - 23 August 2012)	Yes No
Private Short Term Boarding Your name and number will be given to anyone enquiring about short term boarding in Gunnedah (eg Nursing students, mining workers, school teachers, students etc)	Yes No

SECTION 3 | ACCOMMODATION TYPES AND OPTIONS
I am making accommodation available which is located in

Rooms in my home	Self-contained flat	A complete house

Do you smoke inside your home?		Yes No
Do you have a pet cat or dog that you allow inside your home?		Yes No

I/We are happy to have

SECTION 4 | AMENITIES
Please indicate the number of each you have available

Amenities (not outside)	Number available	Exclusive use by guests	Comments
Bathrooms
Toilets – in bathroom
Toilets – separate
En suite

SECTION 5 |HOME INSPECTION
Please indicate the best day/s and time/s during business hours for your home inspection (tick relevant box/es)

Monday	Tuesday	Wednesday	Thursday	Friday
Time:	Time:	Time:	Time:	Time:

SECTION 6 | ROOMS AVAILABLE
Please indicate the number of rooms and bed types for each you will have available.
Complete Part A and Part B if you have a Flat AND Home Rooms available at the same address
Please tick all relevant boxes

PART A – ROOMS IN YOUR HOME OR COMPLETE HOUSE

	AgQuip	Private Short Term Boarding	Comments
Single Rooms (Rooms with 1 single bed, not fold up)
Twin Rooms (Rooms with 2 single beds, not bunk beds)
Double Rooms ( double bed queen bed or king bed)
Triple Rooms ( single beds or double/ queen & single)

PART B – SEPARATE SELF CONTAINED FLAT (WITH OWN BATHROOM & KITCHEN)

	AgQuip	Private Short Term Boarding	Comments
Single Rooms (Rooms with 1 single bed, not fold up)
Twin Rooms (Rooms with 2 single beds, not bunk beds)
Double Rooms ( double bed queen bed or king bed)
Triple Rooms ( single beds or double/ queen & single)

SECTION 7 | DECLARATION FOR RECEIPT OF FULL PAYMENT
By law, if you do not provide an ABN number, Gunnedah Home Hosting can retain 48.5% of your payment for taxation purposes, unless you provide a statement (see below) declaring your reason for exemption. If the statement box below is not applicable to you, more detailed Statement forms with other reasons for exemption are available from the Visitor Information Centre

ABN

If you cannot provide an ABN number please read the statement below and if applicable tick the box

Under the Pay As You Go legislation and guidelines produced by the Australian Taxation Office I provide you with a written statement that, for the supply I am making and further supplies of this type that I make to you:

I supply accommodation to Gunnedah Home Hosting in my capacity as an individual, and the supply is wholly of a private or domestic nature for me Therefore, I am not quoting you with an ABN.

You should not withhold an amount from the payment you make to me for the supply of my accommodation. I agree to advise you in writing if circumstances change to the extent that this statement becomes invalid.

SECTION 8 | PRIVACY DECLARATION

I agree to Gunnedah Home Hosting Disclosing any details provided on this form to Home Host clients or prospective clients.

SECTION 9 | INSURANCE POLICY

You must have private Home and Contents insurance to be a Home Host provider. Please supply your Insurance Company name and your current Home and Contents policy's expiry date for 2012/2013.

Remember you must have Home and Contents Insurance to be a host!
(Registration forms WILL NOT be accepted without this information.)

Please indicate below your home and contents insurance number and expiry date.

Insurance Policy:

Expiry Date:

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