Additional Poly Cart Form Edit Form Name on Account* Phone Number* Service Address* Water Billing Account Number* ** COPY OF DRIVERS LICENSE OR STATE ISSUED ID MUST BE ATTACHED ** File Upload Please note: If you are 65 years or older, you may be eligible for a discount. Please indicate a selection below: Garbage & Recycling Poly Cart Options* 95-Gallon GARBAGE Poly Cart ($5.36 per additional cart PER month) 95-Gallon RECYCLING Poly Cart ($5.36 per additional cart PER month) Both GARBAGE & RECYCLING Poly Cart ($5.36 EACH per additional cart PER month) Number of GARBAGE Poly Cart* Number of RECYCLING Poly Cart* By submitting this form, I understand:* I have requested the additional poly cart(s) listed to be delivered to the above address. I understand I will be billed monthly for the additional carts requested above. If form is emailed/faxed/submitted online, I must call to confirm that form and DL/ID was received. I will be required to keep the additional requested cart(s) for at least six months before I can request for them to be picked up. I must submit a POLY CART PICK-UP REQUEST FORM in order to stop the billing for the additional poly cart(s) and for the carts to be picked up.