Active Military Refuse Discount Application

Active Military Refuse Discount Application
The discount is available for residences with a family member that normally lives in the home and is in full-time military service or is a Guard/ Reservist that is actively deployed. Discounts are to begin at the start of the first three-month billing period following the approval by the Village.
Groot Account Holder Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Account Number*
Email*
example@example.com
Active Military Household Member Full Name*

First NameLast Name
Relationship to Active Member*

SelfSpouseChild
Please provide a copy of either your Groot refuse bill - or - another utility bill (new residents only) showing your name and address

Cancelof
Please provide a copy of either your Orders of Deployment - or - Letter from Command to satisfy proof of active military status.

Cancelof
Sign Here*

First NameLast Name
Email
example@example.com
I certify that all the information contained in this application with attachments is true and accurate.
Today's Date

MonthDayYear
Date
Signature

Clear
Should be Empty: