New Paid Closed Canceled

No Yes

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:

Applicant Details

Email *

Application Fee

Address 2

ZIP *

Signature *

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

Phone Number *

Next Steps

Terms Agreement

Address *

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

City *

State *