New See Notes Cancelled Approved Denied

Yes No

Last Name

Residents must remove doors from appliances prior to pickup.

Add a description and the quantity for each item you are requesting.

Certification

Agree to Terms

White Goods

Begin typing Address and select from the populated drop-down

Items are picked up on the first Friday of each month.

First Name

Applicant Details

Email

Please note microwaves and dishwashers are not White Goods, and are to be collected on your scheduled bulk pickup day.

Item should be placed out after 6 pm the evening before the scheduled pickup day.

Address 2

ZIP

Signature

If the item is no longer in need of pickup, please notify the Township.

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

Phone #

Terms Agreement

Item should be requested at least 48 hours prior to the scheduled pickup day.

Address

By selecting "Yes", I understand and agree to the Terms.

City

State