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2. Type of Request*

   1. Bagged Yard Waste
   2. Special Pickup
4. First and Last Name*
6. Address of Pickup*
   Enter the address where the items need to be picked up.
8. Email Address*
9. Phone Number*
11. Comments
Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field