Trash Pick Up Signup Form

Sign Up for Trash Pick Up
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Pick Up Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
If you wish to sign up for paperless billing, please enter your e-mail address here.
Trash Can*

I already have a can. ($25 per month)I need you to provide a can. ($30 per month)
How do you prefer to receive your bill each month?*

Paper (by mail)E-mailText message (with link to pay online)
When do you need service to begin?*

MonthDayYear
Date
Someone will be in touch with you to confirm you're signed up and to discuss your route day. Thanks so much for choosing us!
Should be Empty:

Sign Up for Trash Pick Up