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2. Authorization Form City of Superior Garbage and Collection Services
4. Agree to Continue or Set Up Garbage Service

   1. I would like to continue garbage collection and disposal service with NO CHANGES at the following service address and I agree to pay all applicable fees.
   2. I would like to continue garbage collection and disposal service WITH CHANGES at the following service address and I agree to pay all applicable fees. Please list number of carts below.
   3. I would like to establish garbage collection and disposal service at the following service address and I agree to pay all applicable fees.
   4. I would like to discontinue garbage collection and disposal service at the following service address and have contracted with a commercial hauler.
6. Service Address:
8. Please fill in the appropriate box below (you must fill in Either the Large Residential or Small Commercial Number of Carts Currently on Site and the Number of Carts Needed;
10. Large Residential:
11. How Many Dwelling Units are in the Property?
12. Number of Garbage Carts Currently on Site
13. Number of Garbage Carts Needed (up to 4 maximum)
    Your bill will be the number of carts at this property x $9.00 per month.
15. Small Commercial:
16. Number of Garbage Carts Currently on Site
17. Number of Garbage Carts Needed (up to 4 maximum)
    Your bill will be the number of carts x $9.00 per month.
19. Notes:
    Please use this field for information on cart placement or special instructions.
21. Please note: Owners of large residential and small commercial properties are required to provide separate containers for the collection of recyclable materials at their own cost in a legal and safe manner. Failure to comply with the City Ordinance can result in a penalty not to exceed $1000 per violation.
23. Name:
25. Mailing Address (if different from service address):
27. Phone Number:
28. Utility Billing Account #:
    Please fill in your City of Superior Utility Billing Acct # if known.
30. Email Address:*
32. Acknowledgement:*

    1. I Agree

    The information within this authorization form is true and correct to the best of my knowledge and belief. I agree to provide updated information should there be any change in the information provided herein.
34. Date of Submission:
    Date of Submission:
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field