“Grab the Can” Program Signup Name * First Name Last Name Email * Lot Number Property Address Address 1 Address 2 City State/Province Zip/Postal Code Country Billing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Select which program (One service for a full six months will cost a discounted $40, or $80 for both to the street and back to house.) To curb FOR pick-up ($8/month From Curb AFTER pick-up ($8/month) BOTH to Curb and Back ($16/month) Start Date MM DD YYYY End Date MM DD YYYY Check here for service to automatically renew every six months until cancelled. No, do not renew automatically Yes, please renew automatically Special Request/Instructions * Thank you!
