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* - Required Field
Full Name *
Street Address *
City *
State *
Zip Code *
E-mail *
Phone Number *
Service Start Date *
Do you currently recycle? *
Yes
No
If you answered "Yes" above, did you...
...use the city's drop off sites?
...use a curbside recycler?
If you chose curbside recycler, Who?
Who is your current trash hauler? *
How did you discover our services? (Check all that apply)
TV
Radio
Newspaper
Direct Mail
Friend/Family
Internet/Search Engine
Facebook
Other
Referred by:
Promo Code
Payment Options *
Pay by mail
Pay by Credit Card
Auto Bill Pay
Pay Plans *
4 Months $10.99 per month (bill $43.96 every 4 months)
8 Months $10.99 per month (bill $87.92 every 8 months)
12 Months $10.99 per month (bill $131.88 every 12 months)
Comments *
I have read and agree to the
Terms of Service
.*
Yes
Service Areas: All of Lincoln
Bennet
Cheney
Eagle
Emerald
Hickman
Holland
Martel
Milford
Roca
Walton
Waverly
More
coming
soon