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2. Date:
   Date:
3. Startup Service Date
   Startup Service Date

5. **Name and address must match Utility Application

7. Name
8. Email Address
10. Garbage Service Address
12. City
13. State
14. Zip Code
16. Phone Number
18. Monthly Billing for Trash pick-up will be charged to your Utility Bill. The rate is $16.00 per container per month.
    -- Select One --(1) container @ $16.00(2) containers @ $32.00(3) containers @ $48.00(4) containers @ $64.00No Trash Service Requested
20. Will you be purchasing a new container from the City?

    1. yes

    1. no

22. TO PURCHASE TRASH CANS contact the City Recorder’s office at 615-451-5895 or visit Gallatin City Hall at 132 West Main Street.

24. If you are not purchasing trash containers from the city please provide serial numbers from the cans you own*

    Service will not begin until serial numbers are provided

26. **Please refer to “Overview of Solid Waste Disposal” information packet for further information regarding trash collection service.
    Overview of Solid Waste Disposal
30. Date
    Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field