YOUR ACCOUNT NO.:
(LOCATED ON YOUR RECENT BILL NO.) 

YOUR NAME:

STREET ADDRESS:

CITY:

STATE:

ZIP:

DAYTIME PHONE:

E-MAIL ADDRESS (optional):

 
ITEMS TO BE PICKED UP:

Note: Be very specific. Only items that are listed will be picked up.
Please read the notes at left.

WHERE IS YOUR TRASH NORMALLY PICKED UP?

Parkway Alley Other
 
Check this box if your Special Collection address is different from your Account address