Poly Cart Pick Up Request Form

Name on Account*

Service Address*

Water Billing Account Number*

*** COPY OF DRIVERS LICENSE OR STATE ISSUED ID MUST BE ATTACHED ***

File Upload DL/ID*

Please indicate a selection below for which cart is to be picked up.

Garbage & Recycling Poly Cart Options*

95 Gallon GARBAGE Poly Cart(s)

95 Gallon RECYCLING Poly Cart(s)

By submitting this form, I understand: I have requested the additional poly cart(s) listed to be picked up from the above address. If form is emailed/faxed/submitted online, I must call to confirm form and DL/ID was received. I will be required to wait at least 4 months before I can request an additional poly cart(s). I must submit this Poly Cart Pick Up Request Form in order to stop the billing for the additional cart(s) and to be picked up.

Signature*

Date Field*

Poly Cart Pick Up Requests

Poly Cart Pick Up Request Form