Allotment Application Form

* indicates required field

Title*

Mr Mrs Miss Ms Dr

First Name:*

Last Name:*

Email:

Address*

Telephone*

Preferred Site*

No preference Battenhall Avenue Bromwich Road Cherry Street Comer Avenue Comer Road Foxwell Street Green Lane Grove The Henwick Road Hill Avenue Hillborough Langdale Drive Lansdowne Crescent Lansdowne Road South Northwick Road Old Northwick Lane Oldbury Road Perdiswell/Droitwich Road Pitchcroft Pitmaston Rogers Hill Timberdine Avenue Waterworks Road Winchester Avenue Windsor Avenue

Preferred Plot (if known)

Preferred Plot Size*

No preference Half Plot (1/32 Acre) Full Plot (1/16 Acre)

Please type the characters you see in the image above*