Application for Multi-Family Sanitation Service
Date
/
Month
/
Day
Year
Date
Name of Owner
*
Address of Owner
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address of Service Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner Contact Number
*
Please enter a valid phone number.
Owner Email
*
example@example.com
How Would You Like to Receive Invoices?
*
Please Select
By Mail (Please see below)
By Email
Mailing Address for Invoices
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Carts Requested (See Note)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Note: (Maximum of Three Carts Per Dwelling) (Maximum of 12 Carts Per Property)
Select a Payment Option
*
Please Select
Monthly
Quarterly
Semi-annually
Annual
City of Dickson Sanitation Policy-As of January 2021
*
Submit
Should be Empty: