Bulky Household Items Collection Request

1. Please enter your details

Name

Address Line 1

Address Line 2

Address Line 3

Postcode

Telephone Number

Daytime

Evening

E-mail Address

How would you like to be contacted?

2. Please give details of the item to be collected

Please give details of the item or items you need to have collected

3. Have you already contacted the council about this?

If yes, who did you contact and when?

Name

Date