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* 1. First and Last Name

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* 2. Address

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* 3. City/Town

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* 4. State

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* 5. Phone Number

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* 6. Please choose none if you do not wish to participate in the recycling program: What size of recycling cart do you need?

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* 7. What size trash cart do you need?

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* 8. Do you need more than 1 trash cart?
**There will be a charge of $2 each month for an additional trash cart on your monthly Utility bill.

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