Garbage or Recycling Can Request Form

2. Please note that the recycling and garbage containers are the property of the City of Homestead and therefore are not to be removed from the property.

   Please note that the recycling and garbage containers are the property of the City of Homestead and therefore are not to be removed from the property.

4. First Name*

5. Last Name*

7. Subdivision and/or Community Name

8. Phone Number *

9. E-Mail Address*

11. Address*

13. City*

14. State*

15. Zip*

17. Service Type*
    -- Select One --Recycling CanGarbage Can

18. Damage*
    -- Select One --Cracked (body)Broken/Missing WheelsBroken/Missing LidBroken HingesBroken/Missing Wheel AxleBurned Can (replacement fee)None

20. Existing Recycling Container at Location*

    1. Yes
    2. No

21. Existing Garbage Container at Location*

    1. Yes
    2. No

23. Repair/Replacement Instructions
    <b><font color="Red"><span style="background-color: #00ffff ">Per repair/replacement request, please leave container at curbside until it has been repaired or replaced.</font></b></span>

    Per repair/replacement request, please leave container at curbside until it has been repaired or replaced.

25. Notes/Suggestions

Leave This Blank:


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

    This field is not part of the form submission.

28. Submit

* indicates a required field