2. 
4. Residential Garbage and Recycling Service Application
6. Form MUST be completed 5 days before you move into this location.
10. First Name*
11. Last Name*
13. I hereby accept responsibility for the garbage bill at:
15. Address 1*
17. Address 2
19. City*
20. State*
21. Zip*
23. E-mail*
25. Phone Number*
29. Mailing address, if different from address above:
31. Address 1
33. Address 2
35. City
36. State
37. Zip
41. Service beginning Date*
    Service beginning Date
43. Multiple Units?*

    1. Yes
    2. No
44. How many?
48. Single Family Roll Cart Service (Check One)*

    1. One 20-gal. roll cart: $19.00 per month (approximately the size of 1 bag of trash per week)
    2. One 32-gal. roll cart: $21.50 month (approximately the size of 3 bags of trash per week)
    3. One 64-gal. roll cart: $26.50 per month (approximately the size of 5 bags of trash per week)
    4. One 96-gal. roll cart: $34.50 per month (approximately the size of 7 bags of trash per week)
    5. Two 64-gal. roll carts: $45.50 per month (approximately the size of 10 bags of trash per week)
    6. One 64-gal. roll cart and one 96-gal. roll cart: $61.50 per month (approximately the size of 12 bags of trash per week)
    7. Two 96-gal. roll carts: $64.50 per month (approximately the size of 14 bags of trash per week)
    8. Premium Back Yard Service + One 20-gal. roll cart: $35.50
    9. Premium Back Yard Service + One 32-gal. roll cart: $38.00
    10. Premium Back Yard Service + One 64-gal. roll cart: $43.00
    11. Premium Back Yard Service + One 96-gal. roll cart: $51.00
    12. Premium Back Yard Service + Two 64-gal. roll carts: $62.00
    13. Premium Back Yard Service + One 64-gal. roll cart and one 96-gal. roll cart: $78.00
    14. Premium Back Yard Service + Two 96-gal. roll carts: $81.00
    15. No Roll Cart (Vacant): $16.50
    16. House under renovations
50. Would you like a recycling roll cart at no extra cost?*

    Recycling is highly encouraged in Athens-Clarke County. Recycling Services are provided at no additional cost to ACC Solid Waste customers. Details available at www.accgov.com/recycling or 706-400-7873.

    1. Yes
    2. No
52. What size?

    1. 32 gal.
    2. 96 gal.
56. I declare that I am the responsible party for the location listed on this form, and I understand and agree to all of the following guidelines:
58. All trash is to be put in a bag and placed into a roll cart. Loose trash will not be collected.*

    1. I understand and agree
60. Roll cart lids must close completely*

    1. I understand and agree
62. Anything outside of a roll cart is considered overflow and requires a visible, prepaid overflow sticker*. Without this sticker, bags outside of a roll cart will not be collected.*

    1. I understand and agree

    *You can purchase prepaid overflow stickers at these locations:
    

    • ACC Solid Waste Department, 725 Hancock Industrial Way
    • ACC Water Business Office, 124 E. Hancock Avenue
64. Roll carts must be placed at the street by 7:30 a.m. on your collection day*

    1. I understand and agree
66. Roll carts must be removed from the curb by noon the day after your collection day*

    For example, if your collection day is Thursday, your roll cart(s) must be removed from the curb by noon on Friday.

    1. I understand and agree
68. Roll carts should be kept two feet (2') from each other and from other obstructions to allow for proper collection*

    1. I understand and agree
70. Roll carts must not be blocked by parked vehicles or other large objects*

    1. I understand and agree
72. Roll carts must be placed at the curb with the handle towards your home to allow for proper collection*

    1. I understand and agree
74. Failure to follow these guidelines could result in your trash and/or recycling not being picked up. A fee of at least $10.00 could be charged to have someone come back to pick up any missed trash/recycling as a result.*

    1. I understand and agree
76. Place only recyclables in the recycling roll cart. *

    When trash or other non-recyclables are put in a recycling roll cart, the recyclable material is considered contaminated and all of the material must be emptied as trash. In these instances, the ACC Solid Waste Department may charge you an additional refuse charge to dispose of the contaminated material. Customers who repeatedly contaminate recycling roll carts will have their recycling roll carts removed.

    1. I understand and agree
78. Final Instructions & Deposit Information

    Thank you for completing the Residential Garbage and Recycling Service Application. Your garbage service fees will be applied to your water bill. Therefore, we have a few more steps to complete you application:

    
    

    1. If you have questions regarding your garbage and recycling services, please call (706) 613-3501 or email SWBilling@accgov.com.
    2. If you are applying for water and sewer service in person, please take a copy of this application and your deposit with you when you go to the Water Business Office located at 124 E. Hancock Ave.
    3. If you are applying for water and sewer service by mail, please print a copy of this application and include it with your Water Service Request Form. Please include your deposit when you mail your applications.
    4. Along with your water deposit, you must pay a $10.00 set-up service fee and a $30.00 deposit for garbage collection.
    5. For more information about starting your water and sewer services, please go to the Water Business Office.
80. Electronic Signature*
81. Date*
    Date
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit Submit and Print

* indicates a required field