Your Information

First Name

Last Name*

Street Number:*

Street Name:*

Address Line 2:

City:

State:

Zip Code (5 digit)*

Phone Number:*

Email Address:*

Preffered Contact Method*

Letter Phone Email

Please select type of trash for pick up.*

Metal Furniture Refrigerator/Freon Items Tree Limbs

Missed trash pick up Missed grass pick up Other

If other is selected, please give a brief description.

Please place items along the curb, but not on the city street. All refrigerators must have doors removed for public safety. DO NOT place items in the alley ways.