Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Type of Phone Number:
Mobile
Home (Landline)
Office (Landline)
Email
*
example@example.com
Would you like to receive emails regarding services and updates?
*
Yes
No
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your billing address the same as your service address?
*
Yes
No
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
WASTE COLLECTION: What size cart would you prefer?
*
35-gallon waste cart
64-gallon waste cart
96-gallon waste cart
No thank you, will use a personal can
RECYCLING COLLECTION: Which size recycling cart would you prefer?
*
35-gallon recycling cart
64-gallon recycling cart
96-gallon recycling cart
No thank you, will use a personal can
YARD WASTE CART: (OPTIONAL) Would you like a 64-gallon or 96-gallon yard waste/food scrap cart for an additional $3.10 per month?
*
64-gallon yard waste cart for $3.10 per month
96-gallon yard waste cart for $3.10 per month
No, thank you
ADDITIONAL CART RENTAL OPTIONS - $3 PER MONTH, PER CONTAINER
I would like additional waste cart(s).
*
64-gallon waste cart
96-gallon waste cart
No, thank you
How many additional carts would you like? DO NOT include your initial cart order in the quantity
*
I would like additional recycling cart(s).
*
64-gallon recycling cart
96-gallon recycling cart
No, thank you
How many additional carts would you like? DO NOT include your initial cart order in the quantity
*
Would you like backdoor trash/recycling service?
*
No
Yes, for additional $15.49 per month billed by LRS
Please also include any messages for LRS customer service, if interested.
SUBMIT
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