* Denotes that the field is mandatory.
If you have previously registered and have forgotten your User Name, contact Customer Service during business hours
Phone 03 5320 5500


Online customers are no longer able to apply for direct debit via eServices.
Further payment option information is available here
Apply for quarterly direct debit arrangements by downloading this Form

Your personal information is being collected by the City of Ballarat for the purpose of processing your request.
For further information view the City of Ballarat's Privacy Policy
Date of Birth
Enter today's date for a Company
*
Company Name
or Surname

*
Given and Middle Names
Leave blank for a Company
Email Address

*
Email Address Confirmation

*
Contact Phone Number *
Address Line 1 *
Address Line 2
Suburb *
State *
Postcode *
If your address has changed please enter your former postal address
Your User Name must be at least six characters long and is not case sensitive. An email address can be used.

WARNING: If this is a COMPANY User Name, please provide a generic company email address, or a generic User Name, rather than using your personal details.
User Name *
Customer Type *