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2. First Name*
3. Last Name*
5. Address1*
7. Phone Number*
8. Email Address*
10. Guidelines

    Stickers are $15 and available at the water office (915 16th Avenue) , customer service desk at both the East Moline Jewel and Silvis Hy-Vee. One $15.00 sticker is equivalent to two larger items and less than 7 bags/boxes of misc items weighing no more than 50 pounds each.  Once a request is received items will be picked up on the next available Wednesday.  Maintenance Services will email you with your scheduled date. • Items should be placed out in a neatly stacked pile where your garbage is normally picked up by 6:00am. • Small items such as clothes, dishes, and toys must be kept together in a bag, box, or container. • Carpet may be set out, but must be cut into 4-foot wide sections, rolled and secured into bundles. •  Special pick ups may not be used for televisions, appliances, construction materials, computer equipment/electronics, used tires, household hazardous materials, green waste, bricks, or concrete.

12. Description of Items*
    Please give us a brief description of items placed out for collection.
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13. 1. Receive an email copy of this form.
14. Email address

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15. Submit

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