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2. Name
3. Account Number
4. Phone Number
6. Service Address
8. Billing Address
10. Email Address
12. Do You Own or Rent?

    1. Own
    2. Rent
13. Type of Residence

    1. Single Family Dwelling
    2. Double Bungalow / Duplex

    1. Triplex
    2. Other
14. If other, explain.
18. Check Service Requested

    1. Make a change to my services
    2. Stop service
    3. Reinstate service
20. Garbage

    1. 35 gallon, every other week collection (must be participating in organic recycling to select this option) $15.21/month (plus state and county solid waste management fees)
    2. 35 gallon, $20.70/month (plus state and county solid waste management fees)
    3. 65 gallon, $25.09/month (plus state and county solid waste management fees)
    4. 95 gallon, $28.85/month (plus state and county solid waste management fees)
22. Recycling

    1. 32 gallon
    2. 64 gallon
    3. 96 gallon
24. Organics Recycling

    1. 32 gallon
26. Change garbage cart size or service level

    1. 35 gallon, every other week collection (must be participating in organic recycling to select this option) $15.21/month (plus state and county solid waste management fees)
    2. 35 gallon, $20.70/month (plus state and county solid waste management fees)
    3. 65 gallon, $25.09/month (plus state and county solid waste management fees)
    4. 95 gallon, $28.85/month (plus state and county solid waste management fees)
28. Add additional garbage cart

    1. 35 gallon, $20.70/month (plus state and county solid waste management fees)
    2. 65 gallon, $25.09/month (plus state and county solid waste management fees)
    3. 95 gallon, $28.85/month (plus state and county solid waste management fees)
30. Remove additional garbage cart

    1. 35 gallon
    2. 65 gallon
    3. 95 gallon
32. Change recycling cart size

    1. 32 gallon
    2. 64 gallon
    3. 96 gallon
34. Add additional recycling cart

    1. 32 gallon
    2. 64 gallon
    3. 96 gallon
36. Remove additional recycling cart

    1. 32 gallon
    2. 64 gallon
    3. 96 gallon
38. Organics recycling

    1. Add cart
    2. Remove cart
40. Date must be provided in order to suspend garbage service
    Date must be provided in order to suspend garbage service
41. Reason for stopping service
43. Reinstate date
    Reinstate date
45. Be advised:

    - Residents may stop refuse / recycling services if the property is vacant for 30 days or more. Garbage and recycling carts must be placed in a secure area.

    - Unless otherwise arranged with and confirmed by the Utility Billing Clerk, services will automatically resume after 3 months.

    - Duplexes / double bungalows must choose at least two containers; triplexes must choose at least three containers. Each unit must have a container of its own.

    - Once a container choice has been made, changes will only be allowed after a three-month period of use.

47. Notes
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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