City of Dunsmuir

Name *

First Name

Last Name

Phone

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Address of pickup location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

In the future, we may be able to provide assistance cutting material. If we are able to do this, would you be interested in this sort of help?

Yes

No

Please read and agree to the following; *

I understand that filling out this form does not guarantee that I will receive assistance, and the assistance being offered is to pick up green waste (not trash) that has already been cut and piled.