City of Shrewsbury
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:*

(Senior Citizen Rate $16.80 **)

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

** Must be 65 + to qualify for Senior Rate

Bulky item pick up once per quarter
White Goods pick up Scheduled with Office
Bulky Items 1-2 Scheduled with Office

No Charge
$18.00
$18.00

65 gallon Cart for Trash	$2.75 each/month	# of units required
65 gallon Cart for Yard Waste***	$2.75 each/month	# of units required
65 gallon Cart for Recycling***	$2.75 each/month	# of units required
Additional 18 gallon Recycle Bin	$1.00 each/month	# of units required
Recycle Bin Lids	$0.50 each/month	# of units required

*** By DNR law, trash and yard waste must be separated and require separate containers

City of ShrewsburyNew Customer Set-Up Form