Service Request Form We will be in touch to set up a secure payment Select your service plan: * ---1 Bin - Monthly Cleaning2 Bins - Monthly Cleaning3 Bins - Monthly Cleaning1 Bin - Quarterly Cleaning2 Bins - Quarterly Cleaning3 Bins - Quarterly Cleaning1 Bin - Yearly Cleaning2 Bins - Yearly Cleaning3 Bins - Yearly Cleaning Preferred Payment Method: * ---CashCheckOther Who picks up your trash? * ---GH Waste ServicesGSI/Glen SharpMetro DisposalKeys/Northshore Disposal ServiceOther/UnknownPontchartrain Waste ServiceProgressive WasteRepublic/Allied WasteRichard’s DisposalRiver Parish DisposalSt Tammany Environmental ProvidersStrancoTeam WasteTchefuncte DisposalThe Local BoyWaste ConnectionsWaste Management of LAWaste Pro of LAWinget’s Disposal What day(s) do they pick up your trash? * Name * Email * Address * City * Zip Code * Phone Number * How did you hear about our service? ---Bin HangerFriendGooglePostcardSocial MediaTruckOther Name of Referrer Is there anything else you feel we should know? * Required By clicking "Send" you are agreeing to our Terms & Conditions.