2. Please complete and submit this form and include a printed copy of the email you receive with your cheque payment. See below for more information on payment options.
4. Payment must be received BEFORE order is porcessed and stickers are delivered.

6. For more information please visit our Curbside Collection page  https://www.salmonarm.ca/369/Curbside-Collection

8. First Name*
9. Last Name*
11. Street Number*
12. Street Name*
13. Street Direction*
14. Apt #
16. City*
17. Province*
18. Postal Code*
20. Telephone No*
22. Contact email:
24. Number of Garbage Stickers:
25. x $3.00 each =
27. Number of Food Waste Stickers:
28. x $3.00 each =
30. Total ( see next section for payment options)
32. Method of Payment:

    1. City Hall Drop Box
    2. Mailed Cheque
    3. Online Banking Payment (the following fields must be completed)
34. Name of Financial Institution
35. Name of Payee on account
37. Delivery Method

    1. Pick up at City Hall
    2. Mail
39. 
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field