Solid Waste Request Form
*All fields must be completed. ---------------------------------------------------------

*Citizen Name :
*Email:
*Address:
*City:
*State:
*Zip:
*Home Phone:
*Work Phone:
*Location:
*Reporting /    Request:	Missed Garbage     Missed Limbs    Missed Leaves        Missed Recycle        Missed Bulky Items        Open Dumping in Neighborhood Trash Can Left in Street        Other (Write into Comment box)
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*Please Pick-Up	Storm Debris on my Curb Tires at my Curb (pick-up Wednesdays*) White Goods at my Curb (pick-up on Wednesday*)
*Please describe the location for this request:
*Comments:
*Agreement:	You have acknowledged and filled out all fields pertaining to the City of Jackson Solid Waste Request Form..
You may also call us between 8:00am - 5:00pm Monday through Friday at 601.960.1193