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2. Name (First and Last)*
4. Address (Do not include P.O. Address)*
   P.O. addresses are not accepted.
6. City
7. State
8. Zip Code*
   49002 or 49024
10. Phone Number*
11. Email Address*
13. Do you currently have a cart?*

    1. Yes
    2. No
15. Please select a cart size:*

    1. 96-Gallon Cart
    2. 64-Gallon Cart
17. Are you a new resident to Portage?*

    1. Yes
    2. No
19. Disclaimer
    The City of Portage and Best Way Disposal will use this information to process your request and will not sell, share, or distribute your personal information to third parties.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field