Last Name / Co. Name:
                  First Name:
             Phone Number:
             Email Address:
                       Address:
                             City:
                            State:
                               Zip:

    Requested Start Date:

             Basic Service, plus any of the following:
             PolyKart (yes/no): $3.00/month
        Yard Waste (yes/no): 6 month plan - service May - Oct
        Yard Waste (yes/no): 9 month plan - service Mar - Nov
        Yard Waste (yes/no): 12 month plan - service Jan - Dec
Yard Waste Cart (yes/no): additional $15.00 annually / $3.00 per month
                                                                                        for additional cart.

Senior Citizen / Disabled Citizen (yes/no): 7% discount on all residential services!

 
Comments:


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