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2. Name
4. Service Location Address
6. Billing Address
8. City
9. State
10. Zip Code
12. Email Address
14. Phone Number
16. Is This a Rental Property?
    -- Select One --YesNo
18. Service Level
    -- Select One --20 Gallon Can - $16.00/month35 Gallon Can - $22.75/month64 Gallon Can - $29.00/month96 Gallon Can - $35.75/month160 Gallon Can - $41.75/month
20. Required:

    1. I understand and agree to the below statements.

    (1) I am electing the collection service at the residence indicated above. (2) I agree to pay the fees as set by the Town of Mansfield and agree to abide by the Town’s Solid Waste Ordinance and Regulations. (3) Bills are mailed out quarterly in advance of service. (4) Owner occupied residences - I am responsible for recycling. Recyclables mixed in the trash may result in the trash not being taken or fines being issued. (5) Landlords - I am responsible for informing new tenants about what to recycle. Recyclables mixed in the trash may result in the trash not being taken or fines being issued. (6) Trash and recyclables should be placed by the road before 6 a.m. on the day of collection. (7) The containers are property of the trash contractor. The charge for a missing container is $100. Containers need to be returned at the time of service cancellation to avoid a missing container charge.
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field