Required fields are marked with asterisks (*)

Change in Service Request Form

This Form is to be used when you want to request a change to the number of bins assigned to your property.

Associated Fees:

Additional bin(s) request: $171 for a single or set of bins + $100 delivery fee + completion of Change in Service Form
Bins requested at a new property opting into the municipal curbside collection program: $171 for a set of bins (no delivery fee).
Removal of bins is $100 delivery fee for pick up and a credit for the remainder of the year

Personal Information:

Name:

Date:

Address:

Phone Number:

Email Address:

I would like to request:

Add a Waste Roll-Out Bin

Add an Organic Waste Roll-Out Bin

Remove a Waste Roll-Out Bin

Remove an Organic Waste Roll-Out Bin

Opt out of Waste Collection (I agree that I will self-manage my solid waste produced on this property and will dispose of all waste in accordance with the law.)

I understand that an invoice will be sent to the property owner, and Waste Management will coordinate service once payment has been recieved by the Municipality

Yes

Signature:

Clear

FOR OFFICE USE ONLY

Approved, Treasurer:

Clear

Date Approved: