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City of Roswell - Landfill Account Application

2. CITY OF ROSWELL
   Landfill Account Application

   Landfill Account Application

4. Name of Business or Applicant:*

5. Email Address (if available):

7. Mailing Address:*

9. City:*

10. State:*

11. Zip Code:*

13. Phone Number:*

14. Fax Number:

16. Contractor, Business, or Driver License Number:*

18. Person(s) permitted to charge to account:*

20. Type of Material Disposed of:*
    -- Select One --Construction MaterialsRoofing MaterialsYard DebrisElectronic WasteHousehold Hazardous WasteTiresCardboardMetalHousehold Trash

22. Date submitted*
    Date submitted

    Date submitted

Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field