Application for Trash Bin

Application for Waste Collection Service

To guarantee your bin is included with the next delivery, please submit this form before 2:30 PM (CST) on Tuesday. Forms submitted after 2:30 PM on Tuesday will not receive their bin with the next delivery. Please place your current bin on the curb on Tuesday evenings to be picked up on Wednesday mornings. Your new bin will be delivered on Wednesday.
Name of Authorized Household Member*

First NameLast Name
Address*

Address 1

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Driver's License #*
Driver's License State*
The undersigned applies for waste collection services for the Municipal Utility District, which is the sole provider of such services in Heartland, and agrees to the following terms and conditions of service.

1. Collections and Cost
Each residence will be furnished with a 95-gallon roll-out cart, which will be picked up once per week at an initial cost of $15.75 per month. Billings will be included on the same bill as bills for water and sewer service, except that billings for waste collection service may be in advance. A 2nd cart will be charged an additional $6.00 per month in addition to the $15.75.

2. Extra Waste
All waste shall, to the maximum extent possible, be placed within the roll-out container. Any waste not placed within the cart shall be placed in a securely tied garbage bag and placed beside the cart. Residents may request and will be supplied with additional containers at an additional cost of $6.00 per month per cart.

3. Collection Times and Cart Storage
Carts are to be placed out no sooner than dusk on the night before collection and must be retrieved and properly stored by 7:00 p.m. on the day of collection. Carts and all waste containers must, outside these hours, be stored behind the front building line in a location screened from the street (behind a fence, in a garage, etc.).

4. Cart Maintenance
Residents are encouraged to place waste within plastic bags, securely tied, within the carts, in order to maintain the carts in a sanitary condition. Carts must be kept by their users in a reasonably clean condition and must be periodically
washed out, if necessary to prevent the build-up of residues or odors.

5. Bulky Waste
Bulky waste will be picked up on your scheduled trash day. Large, special, one-time collections may be arranged through Waste Management at an additional cost beyond regular monthly fees.

6. Cart Ownership
Damages. Roll-out carts are the property of the waste hauler and are provided as a convenience to residents. Residents are responsible for damages to carts caused by their own actions or negligence.

7. Prohibited Waste
Residents shall not place within roll-out carts or other containers for collection any medical waste, petroleum products, lead-acid batteries, pesticides, hot coals, corrosive waste, or any other substance classified as toxic or hazardous under
state or federal law and/or ineligible for disposal in a sanitary landfill.
Please select from the list below.*

I have a new build and need a new cart for $15.75/mo.I have a broken cart and need a replacement.My cart is missing, and I need a replacement.None of the above.
Would you like to add a second cart for an additional $6.00/per month?*

Yes, please add a second cartNo, I only need one cart.
What is the current cart number on your trash cart that needs to be replaced? *
Carts cannot be replaced if they are full of trash or debris.
Do you need a trash bin picked up ONLY? *
Carts cannot be picked up if they are full of trash or debris.
Signature of Authorized Household Member*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Application for Waste Collection Service