Recycling Bin Order Form

2. <i>Forms may not function properly if using Microsoft Internet Explorer 9 (IE9) or earlier. If you experience issues, please call 866-NEW-BINS (866-639-2467).</i><br><br>

   Forms may not function properly if using Microsoft Internet Explorer 9 (IE9) or earlier. If you experience issues, please call 866-NEW-BINS (866-639-2467).
   
   

4. First Name*

5. Last Name*

7. Address (House Number and Street Name)*

9. City*

10. Zip*

12. Telephone*

    If no telephone, enter 555-555-1234.

13. Extension

15. Email Address

    If you would prefer a response to your questions by email, please enter to address here.

16. Please add me to the SWA's monthly eNewsletter, Waste Matters.*

    1. Yes

    1. No

18. Community Name (Subdivision / Development)

19. How do you take out your trash and garbage?*

    1. I put trash and garbage in a can at the curb.
    2. I put trash and garbage in a dumpster I share with others.

21. Are these new, replacement, or additional bins?*

    1. New Bins
    2. Replacement Bins
    3. Additional Bins

23. What bins would you like?

    
    
    Blue bins are for plastic containers, aluminum cans and glass; the yellow bins are for cardboard and paper.
    
    The larger, round blue bins are for families who need a larger container for their blue bin materials.
    
    
    

    1. 18-gallon yellow recycling bin

    1. 18-gallon blue recycling bin

    1. 25-gallon blue recycling bin
       (Not available to residents of the Town of Palm Beach.)
25. Would you like apartment bags?

    These are reusable bags used to collect recyclables in your home and transport them to the larger blue and yellow bins located in the dumpster area of your building.
    

    1. Yes
27. How did you hear about our website?*

    (Click all that apply.)

    1. Mailer
    2. Newspaper
    3. Radio Ad
    4. Radio Station Website
    5. Television Ad
    6. Television Station Website

    1. SWA Vehicle Bumper Sticker
    2. Bus Stop Ads
    3. Side of Bus Ads
    4. Event
    5. Other
29. Comments

Leave This Blank:


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

    This field is not part of the form submission.

32. Submit

* indicates a required field