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FIRST NAME

LAST NAME

PRIMARY PHONE CONTACT

SECONDARY PHONE CONTACT

EMAIL

ADDRESS OF JOB SITE

PROPOSED DATE AND TIME

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Day

Year

Time

HoursMinutes

City Trash will aim to deliver services as close as possible to the proposed date subject to availability.

JOB CLASSIFICATION

Residential Junk Removal

Commercial Junk Removal

Special Services including Hoarder Cleanout

Handyman Services

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By submitting this form, I agree to be contacted by a representative from City Trash via the communication channels above. Data charges may apply where applicable.

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