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2. The City is working to improve the quality of residential sanitation service.  We understand that this change has meant that your service has been discontinued. Or, if you are a new city resident,  you may need to find a provider.  

   
   

   Please complete this form so we can determine how best to serve you during this change.  If you still have service, we would ask that you stay with your current provider until the new program is in place. 

   
   

    We apologize for any inconvenience.  

6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. Zip*
15. Cell Phone Number*
16. Email Address*
18. Would you like to receive updates on the program rollout?*

    1. Yes
    2. No
20. Current or Most Recent Provider*
    -- Select One --Fulton SanitationGFLLatham SanitationReliable SanitationT&RWasteProNo Service
22. Reason for Needing Service*
    -- Select One --Moving into a New ConstructionNew Resident/Property OwnerReceived Notice Service was Being Disconnected
24. If Notice of Termination, what is the effective date?
    If Notice of Termination, what is the effective date?
25. Do you currently have active service?

    1. Yes
    2. No
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field