Bulk Trash Pick-Up Form

Date: *

Time *

First Name: *

Last Name: *

Email Address: *

Telephone Number: *

Street Address. *

Ward Number *

Select your week(s) for Ward 1 *

Ward 1 - April 1st - 5th
Ward 1 - May 6th - 10th

Select your week(s) for Ward 2 *

Ward 2 - April 8th - 12th
Ward 2 - May 13th - 17th

Select your week(s) for Ward 3 *

Ward 3 - April 15th - 19th
Ward 3 - May 20th - 24th

Select your week(s) for Ward 4 *

Ward 4 - April 22th - 26th
Ward 4 - May 27th - 31st

Consent for storing submitted data *

Yes, I give permission to store and process my data
No, I don't consent to storing and processing my data

Security Verification *