Damaged Cart Form

2. Please fill out the form below to request the repair or replacement of your garbage or recycling cart.

   Please fill out the form below to request the repair or replacement of your garbage or recycling cart.

4. First Name*

5. Last Name*

7. Street Number*

8. Street Name*

9. Apt #

11. City

12. State

13. Zip

15. Phone number*

16. NBU or GVEC Account Number*

18. Email*

20. Cart Type*
    -- Select One --Garbage-96 gallonGarbage-48 gallonRecycle-96 gallonRecycle-48 gallon

21. Cart Serial Number*

22. Type of Damage*

    1. Broken Lid
    2. Broken Hinges
    3. Missing metal bar
    4. Cracked body
    5. Broken Wheels
    6. Other

24. Comments

26. Please allow three business days to process your request.

    Please allow three business days to process your request.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field