Bulk Collection Request

4. First Name*
5. Last Name*
7. Name on Utility (Water/Sewer/Refuse) Account*

   If you are not the primary account holder, you cannot make this request.

9. Address*
11. Contact Phone #*
12. Email Address
13. Are You A Current Refuse Customer?*
    -- Select One --YESNO
14. Are Items Currently Out?*

    If you checked yes, please be aware for future collections that items shall not be placed out prior to receiving a confirmation for collection from the Public Works Department.

    1. Yes
    2. No
16. Description of Items for Collection:*
18. Bulk Collection Guidelines
    
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field