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2. About our Services
   The City of Sallisaw offers curbside pickup of residential bulk trash items for city residents. To schedule a curbside bulk waste pick up service, please complete the fields below or call City Hall at 918-775-6241. If you do not have a city utility account number, or you are a commercial type customer, please call city hall to make other collection and payment arrangements.
3. 
5. Date of Request*
7. By checking the box below, customer agrees to pay any fees associated with the curbside waste pick up services. These fees will be added to the customer's utility billing statement. A minimum $25.00 fee will be charged for the services up to 10 cubic yards of waste. For all waste over 10 cubic yards, a $3.00 per cubic yard fee will be applied. *

   1. Yes I agree to pay fees related to these services. I also agree to have charges added to my utility billing statement.
9. Name on Utility Account*
11. Name of Person Requesting Service*
13. Service Address. (Waste pick up services will only be provided at the utility billing address)*
15. Utility Account Number*
17. Contact Phone*
18. Email Address
20. Number of Piles*
    -- Select One --123More than 3
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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