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2. Commercial Garbage Request

4. Date*
   Date
5. Effective Date: *
   Effective Date:
7. Account Name:*
8. Account Number:*
10. Service Address*
12. City*
13. State*
14. Zip Code*
16. Business/Office Phone #:*
17. E-Mail:*
19. Do you currently have a garbage cart:*
    -- Select One --YesNo
20. Request for garbage cart:*
    -- Select One --YesNo
22. Order _____ additional garbage cart for once a week pick-up. *
24. Order _____ additional garbage cart for twice a week pick-up. Food service establishment only.*
26. Dumpster Request*
    -- Select One --YesNo
27. Lockable Dumpster:*
    -- Select One --YesNo
28. Dumpster Size*
30. Quantity:*
31. Times per week pick-up:*
32. Preferred days:*

    1. Monday
    2. Tuesday
    3. Wednesday

    1. Thursday
    2. Friday
34. Cancel _____ dumpster.

36. Note: Carts will be delivered within 7-10 business days from date requested. Cart requests submitted after 1:00 pm will not be submitted until the next business day. 

    Code of Ordinances, Sec. 23-31 (b) - Customers may not place carts in the street right-of-way for collection earlier than 12:00 p.m. (noon) the day before the day of collection and no later than 7:00 a.m. of the day of collection. Emptied carts must be removed from the street right-of-way no later than 8:00 a.m. on the morning following the day of collection. 

38. 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.
40. Electronic Signature*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field