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2. First Name*
3. Last Name*
5. Address1*
7. Phone
8. Email
10. Preferred Contact Method:

    1. Phone
    2. Email
12. Select Service Type

    1. Garbage collection
    2. Recycling
    3. Special bulk pick up
14. Check all issues that apply:

    1. Curbside service not collected
    2. Workers were littering
    3. Workers threw recycling bins
    4. Workers were driving unsafely
    5. Workers damaged my property
    6. Recycling bin was damaged
15. Did the problem happen at your home only, or at multiple homes in your neighborhood?

    1. My home only
    2. Multiple homes
17. Additional comments:
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field