Residential Preregistration Form

Recycling Preregistration / Survey

We are looking to bring responsible waste services to your area. Please fill out the form below to help us better serve the needs of your area. THE FORM BELOW IS ONLY IF YOU ARE OUTSIDE OF THE ZIP CODES 39202, 39206, 39216, and 39211
I am interested in the following services/programs:*

Glass Recycling PickupPaper, Plastic, and Metal Recycling PickupFood Waste PickupElectronics Recycling PickupRecycling Drop OffUnsure
Considering the price of $5 to $10 per pickup per program, I am MOST interested in having pickups:*

WeeklyEvery Other WeekMonthlyTwice a weekUnsure
I would rather:*

Pay annually to save moneyHave the payment draft monthlyUnsure
Would you be willing to put a yard sign up temporarliy to help promote the service?*

YesNo ThanksUnsure
Name*

First NameLast Name
Name of Neighborhood
Current Garbage Collection Days*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*

Confirmation Email
Phone Number

Area CodePhone Number
Additional Comments
Should be Empty:

Recycling Preregistration / Survey