Type Full Name :
Sign With Hand
Last Name
Organization Name
Add a description and the quantity for each item you are requesting. Limit six (6). *

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

*
{[CNAME]}
Terms Agreement and Certification
Bulk Pickup Details
Begin typing Address and select from the populated drop-down
Chair
Couch and Chair
Description
Mattress
First Name
Amount Due
Customer Details
Email
Fee
Dryers
Free (Recyclable)
Address 2
ZIP
Couch
Signature
Miscellaneous Items
Service Fee
By signing below, I the owner certify that all of the information provided in this application is true and accurate.
{[PNAME]}
Has to be wrapped
Phone #
Service Fee $5.00
Mattress $20.00 per unit
Small TVs $15.00 per unit
Large TVs $20.00 per unit
Couch $20.00 per unit
Chair $15.00 per unit
Couch + Chair $25.00
Miscellanious Item Fee Varies
Free (Recyclable)
Refrigerators
Washers
Large TVs
Small TVs
Fees for Miscellanious Items May Vary
Address
By selecting "Yes", I understand that Household pickup cannot contain electronics, metal items, hazardous waste, construction material.
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
https://chesapeake.wv.gov/
Free (Recyclable)
Quantity
City
State