Please complete all required fields! Fields marked with (*) are required. Status(*) New CustomerExisting Customer Please select one Contact Information Name(*) Required Email(*) Required / check address Phone(*) Required Enter the best # to reach you during the day Billing Address Street Address(*) Required City(*) Required State(*) KSALAKAZARCACOCTDEFLGAHIIDILINIAKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Required ZIP(*) Required Pickup Address (if different from billing) Street Address Required City Required State KS Required ZIP Required Desired Startup(*) Month010203040506070809101112 / Day01020304050607080910111213141516171819202122232425262728293031 / Year20142015201620172018201920202021202220232024 Required Additional Options Curbside Recycling(*) NoYes Invalid Input Adds an additional $6 to monthly service bill Auto-Pay(*) NoYes Required We will contact you to set this up. Invalid Input Complete Sign-up Reset We will contact you with your pickup day of the week for your trash and recycling (if necessary).
