Bin Request Form

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Contact Information

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Contact Information

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Address 1

Address 2

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Drop Additional Bin	By requesting an additional Trash Bin (Green), you agree to the reoccurring fee of $8.50 that will be included on your monthly Utility Bill. It will also be required that you maintain possession of the additional Trash Bin (Green) for a minimum of six months. Recycling Bins (Blue) may be requested without an additional charge.
Repair/Replace Bin	Bins must be physically damaged for consideration. Please provide a detailed explanation of the damage to the bin in the Notes section below (i.e. broken lid, missing wheels, cracked body).
Remove Excess Bins	Select this option if you have more than one Trash Bin (Green) and/or one Recycling Bin (Blue) at your residence and would the excess bins removed.

Requested Service

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Requested Service

Bin Color

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Bin Color

Trash (Green)

Recycling (Blue)

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