Citizen Order Form

Citizen Order Form
Submit your request for city-provided products or services. Please complete all required fields.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Delivery Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Product or Service Selection
prevnext( X )
Bulk Trash Pickup
Request a scheduled pickup for large household items.
$25.00

Tree Planting Service
Order a tree planting at your residence.
$50.00Quantity

Recycling Bin Delivery
Request a new or replacement recycling bin.
$10.00

Street Light Repair
Report and request repair for a broken street light.
Free

Water Service Connection
Order a new water service connection.
$100.00

Total
$0.00
Preferred Delivery or Service Date
MonthDayYear
Date
Preferred Time Window
Preferred Delivery or Service Method
Order Quantity (if applicable)
Additional Notes or Special Instructions
Upload Supporting Documents (optional)
Cancelof
Should be Empty: