City of Lake Saint Louis
New Customer Set-Up Form

Please fill out the form below to begin using our services.

New Customer Set-up Form

All information flagged with the red asterisk (*) must be filled out before submitting the form.

Customer Name:*

Date:*

Email Address:*

Service Address:*

City:*

Zip Code:*

Phone Number:*

Alternate Phone Number:

Billing Information if different than service address:

Billing Address:

Billing City:

Billing Zip Code:

DL/SSN #:*

DOB:*

STANDARD SERVICE for $17.74 per month Includes:

(Senior Citizen Rate $16.10 **)

Once a week Pickup.
   Trash
   Yard Waste ***
   Recycle Bin (one 18 gal bin included)*

* Please check if you plan to recycle
** Must be 62 + to qualify for Senior Rate

Ask About Optional Services Available

Additional Trash Pick Up per week	$8.00 per month	Yes No
Senior Citizen Rate for 2 × PU	$7.00 per month	Yes No
White Goods pick up Scheduled with Office Bulky Items per hopper load		$20.00 $20.00

96 gallon Cart for Trash	$2.00 each/month	# of units required
96 gallon Cart for Yard Waste***	$2.00 each/month	# of units required
Additional Recycle Bins or carts	$2.00 each/month	# of units required
Recycle Bin Lids	$0.50 each/month	# of units required
Container Swaps	$3.00 each/time	# of units required

*** By DNR law, trash and yard waste must be separated and require separate and approved containers,. An approved container must be leak proof, fly proof and fly tight. Nothing can be outside of an approved container.

Copyright Christian Environmental Services

City of Lake Saint LouisNew Customer Set-Up Form

STANDARD SERVICE for $17.74 per month Includes:

Ask About Optional Services Available

City of Lake Saint Louis
New Customer Set-Up Form