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2. Name*
4. Select one*

   1. Property owner
   2. Resident
6. Address of collection request*
8. Option 1: Extra Solid Waste Pickup
   I do hereby and voluntarily request an Extra Solid Waste Pickup. I understand that this service comes with a separate and additional charge(s); that the collection is timed; and that the fee for the service is based on the amount of time it takes City staff to pick up the solid waste that has been properly placed at the curbside for disposal. I understand I will be billed for this service and agree to pay the extra fee of $15 for the first minutes, plus $7.50 for each additional and partial minute.
10. Please select which day of the week you would like to schedule your extra solid waste pickup

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    Items are to be placed curbside by 7am on the day selected.
12. Please state what items will be placed curbside
14. Option 2: Extra Volume Collection
    I do hereby and voluntarily request Extra Volume Collection. I understand that this service comes with a separate and additional charge; that the collection is timed; and that the fee for the service is based on the amount of time it takes City staff to pick up the extra volume that has been properly placed at the curbside for disposal. I understand I will be billed for this service and agree to pay the extra fee of $10 for every 2 minutes of the collection.
16. Extra volume collection is only available on Fridays, with the exception of weeks in which the City observes a holiday. Do you request extra volume collection?

    1. Yes
    2. No

    Items are to be placed curbside by 7am on the Friday following this request.
18. Please state what items will be placed curbside
20. My billing address and contact information are as follows:
22. Name*
23. Company
24. Phone*
26. Address*
28. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Agreement*

    By my signature and date below, I hereby agree that I have ordered and will pay all fees associated with an Extra Solid Waste Pickup.

    1. I agree.
32. Electronic Signature*
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field