* First Name * Last Name

Billing Address

* House (PO) Number

Street Prefix
(North, South, East, West)

*Street Name

* Street Suffix
(Lane, Way, Street, Court)

* City

* State

* Zip

Service Address

* House Number

Street Prefix
(North, South, East, West)

*Street Name

* Street Suffix
(Lane, Way, Street, Court)

* City

* State

* Zip

E-Mail * Phone

You may request 96-gallon carts for garbage and 18-gallon bins or 64-gallon carts for recycling.

Base rate of $14.20 per month ($42.60 per quarter) includes weekly garbage and recycling service.

As an upgrade to the base rate you may request:

Garbage Collection Choices

YES, I would like to start (continue) having garbage and recycling collected at my residence on January 1, 2010. I would also like to have a 96 gallon cart delivered. The rate for this service is $17.70 per month or $53.10 per quarter.

Number of additional carts:

$3.50 per month $10.50 per quarter

YES, I would like to start (continue) having garbage and recycling collected at my residence on January 1, 2010. However, I do not want a 96 gallon cart delivered. The rate for this service is $14.20 per month or $42.60 per quarter.

Recycling Collection Choices

64-gallon recycling cart for an additional $3.00 each per month ($9.00 per quarter)

Number of additional carts:

$3.00 per month $9.00 per quarter

18-gallon recycling bin for an additional $0.35 each per month ($1.05 per quarter)

Number of additional bins:

$0.35 per month $1.05 per quarter

I will purchase blue bags separately for my recycling service.