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Last Name
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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).
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EXCLUDED ITEMS: METAL ITEMS, CONSTRUCTION DEBRIS, ELECTRONICS, HAZARDOUS MATERIALS.
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{[CNAME]}
Certification
Agree to Terms
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Bulk Pickup Items
Begin typing Address and select from the populated drop-down
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First Name
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The fee for this application fee is:
Applicant Details
Email
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Application Fee
Address 2
ZIP
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Signature
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By signing below, I the owner certify that all of the information provided in this application is true and accurate.
{[PNAME]}
Phone Number
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Next Steps
Terms Agreement
Address
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By selecting "Yes", I understand that Household pickup cannot contain, electronics, metal items, hazardous waste, construction material.
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
City
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State
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Item Description
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Add Pickup Item Details
Quantity
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