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2. Request to Replace, Damaged, Missing or Dirty Cart

   To request that one or more of your carts be exchanged for another cart, please fill out the form below and indicate the reason for the exchange. Please be aware that an exchange may be subject to fees to cover the cost of exchanging the cart. 

   If you believe that your cart was damaged by Waste Connections during service, then please check the appropriate box below and the Town of Northlake will initiate an investigation of your issue with Waste Connections.

4. ​Do you believe that your cart was damaged by Waste Connections?

   1. Yes
   2. No
8. Account Information
10. Address*
12. Phone Number*
13. Email Address*
15. Account Number

    Enter the account number from your bill for the account that you wish to exchange carts.

17. Route Number*
18. Service Address ID*
19. Resident Number*
21. Cart Exchange/Replacement Information
23. What type of carts need to be exchanged or replaced?*

    Select all that apply

    1. Trash
    2. Recycling
25. What is the primary reason for requesting this exchange*

    1. Damaged
    2. Missing/Lost
    3. Dirty
    4. Other
27. If other or damaged, please describe the reason for requesting the exchange or how the cart was damaged:
29. Would you like to have your cart(s) exchanged/replaced with new or used cart(s)?*

    1. New ($50.00 per cart)
    2. Used ($15.00 per cart)

    Please fill out this section even if you have requested an investigation related to damages. A Town representative will contact you with the results of the investigation prior to charging you for a new or used replacement cart. 

31. Authorization of Services*

    I am the owner of this account, and I am requesting an exchange or replacement for one or more trash and/or recycling carts for this account. I agree to pay any fees associated with covering the cost exchanging the carts ($50.00 per requested new cart or $15.00 per requested used cart). I am aware that charges related to this service request will be charged on my next utility bill. 

    1. Yes, I agree to the above statement and agree to pay the required fees for exchanging/replacing carts.
33. Name of the Account Holder*
34. Date*
    Date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field