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2. Service Change Request

   The inclusion of an additional trash cart to your weekly service will add an additional 35% to your quarterly trash bill.  
   For the current quarterly rates, please see the Trash and Recycling Billing page.

   1. Additional Trash Cart
   2. Change to Curbside Service
   3. Change to Rear Yard Service (driveway <100')
   4. Change to Rear Yard Service (driveway >100')
4. First Name*
5. Last Name*
7. Property Address*
9. Mailing Address

   (If different than the Property Address)

11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email Address*
20. Billing Acknowledgement*

    • I acknowledge that by making this request, my account will be adjusted, and my next bill will reflect accordingly at the current quarterly rate.
    • I express my intent to enter into this Agreement willingly and voluntarily, and understand this Agreement will be effective until revoked in writing.

    1. I agree.
22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that: 
    1) your application will not be signed in the sense of a traditional paper document, 
    2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 
    3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature*
25. Today's Date*
    Today's Date
27. Delivery Information

    Once your request is submitted, it will go directly to:

    1. Whitetail Disposal, who will update their service list, and arrange to deliver an additional can (if applicable)-please allow up to two (2) weeks for delivery;
    2. Easttown's Finance Department will add the additional service to the next quarterly bill.
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

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