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2. Name*
3. Email Address*
5. Address of Property Requesting Bulk Pick Up*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Date To Pick Up Bulk Item/Items*
    Date To Pick Up Bulk Item/Items
14. Items and Quantity Needing To Be Picked Up*
16. Note
18. *Information

    The cost for bulk items are $15.00 each. If you are needing to have a mattress/box spring picked up, it will cost $30.00 each and you will need to give a week's notification. These fee's will be added to your Utility bill.

    This application is an exclusive contract between the City of Clearwater, Sedgwick County, Kansas, and the applicant at the above address. The applicant agrees to be responsible for all payments for the bulk trash services at the above address from the date service under this application is commenced until service is terminated by notice.

    
    

    
    

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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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