New Paid Closed Canceled

No Yes

Yes No

Yes No

Last Name

Organization Name

You will be contacted when a date and time for your Bulk Pickup is scheduled. Please note that payment must be made in full prior to the scheduled date.

Add a description and the quantity for each item you are requesting. Limit six (6).

EXCLUDED ITEMS: METAL ITEMS, CONSTRUCTION DEBRIS, ELECTRONICS, HAZARDOUS MATERIALS.

Certification

Agree to Terms

Bulk Pickup Items

Begin typing Address and select from the populated drop-down.

First Name

The fee for this application fee is:

Is this a corner property?

Applicant Information

Email

Application Fee

Address 2

ZIP

Signature

Corner Property Side Street and Driveway Location

By signing below, I the owner certify that all the information provided in this application is true and accurate.

Phone #

Next Steps

Terms Agreement

Address

By selecting "Yes", I understand that Household pickup cannot contain electronics, metal items, hazardous waste, construction material.

City

State