Schaumburg Cart Form

Name*

First NameLast Name
Phone
Please enter a valid phone number.
Type of Phone Number

MobileHome (Landline)Office (Landline)
Email*
example@example.com
Would you like to receive emails regarding services and updates?*

YesNo
Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is your mailing address the same as your service address?*

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
WASTE COLLECTION: What size cart would you prefer?*

35-gallon waste cart64-gallon waste cart96-gallon waste cartNo thank you, will use a personal can
RECYCLING COLLECTION: Which size recycling cart would you prefer?*

35-gallon recycling cart64-gallon recycling cart96-gallon recycling cartNo thank you, will use a personal can
YARD WASTE CART: (OPTIONAL) Would you like a 64-gallon or 96-gallon yard waste/food scrap cart for an additional $3.20 per month?*

64-gallon yard waste cart for $3.20 per month96-gallon yard waste cart for $3.20 per monthNo, thank you
ADDITIONAL CART RENTAL OPTIONS - $3.20 PER MONTH, PER CONTAINER
I would like additional waste cart(s).*

64-gallon waste cart96-gallon waste cartNo, thank you
I would like additional recycling cart(s).*

64-gallon waste cart96-gallon waste cartNo, thank you
Would you like backdoor trash/recycling service?*

NoYes, for additional $15.99 per month billed by LRS
Please also include any messages for LRS customer service, if interested.
Should be Empty:

ADDITIONAL CART RENTAL OPTIONS - $3.20 PER MONTH, PER CONTAINER