Residential
Agreement
Form [PDF]

First Name _____________________________________________

Last Name _____________________________________________

Address _______________________________________________

City: ________________________________  Zip ______________

Mailing Address (If different)_______________________________

City: ________________________________  Zip ______________

Home Phone __________________________________

Work Phone ___________________________________

email (optional) _________________________________

BILLING (ONCE PER MONTH PICKUP)

(Please check one of the following, and provide additional information as needed)

CITY BILLING

____ I own/rent the residence listed above, and the City utility bill for the residence comes in my name. (If you check this box, the $1.75 recycling service charge will be added to the monthly utility bill.)

____ I reside at the address listed above, but my name is not on the City utility bill. (e.g., the landlord pays the utilities.)

Enclosed is a check for $______ for _____ months of service made out to The City of Grand Junction.

____ I own/rent the residence listed above, but do not receive a City utility bill of any kind.

Enclosed is a check for $_______ for _______months of service made out to GJ CRI.

REQUEST & BILLING FOR A SECOND PICK UP EACH MONTH

YES! I WOULD ALSO LIKE A SECOND PICK UP EACH MONTH: ______(Initial) Please include a check for $25.00 made out to GJ CRI. This is the annual fee for the second pick up each month. (You will also have $1.75 per month added to your monthly trash bill. The total cost for twice a month service is $46.00 annually, or $3.83 per month.)

CONTAINERS

(Please check one of the following)

FREE CONTAINERS

With a one year subscription, up to four regular curbside recycling bags are provided free of charge.

____ I would like _____ (up to four) free regular curbside recycling bags.

____ I prefer to provide my own containers. Please do not deliver any curbside recycling containers.

ADDITIONAL CONTAINERS AT ADDITIONAL COST

Additional containers are available for purchase. Prices include tax and delivery:

____ I would like _____ extra regular curbside recycling bags (22 gallon polypropylene) at $3.50 each.

____ I would like _____ plain, self standing, square bottom bags at $4.50 each.

____ I would like _____ red, open, stackable recycling bins at $12.00 each.

(These are UV resistant, 18 gallon containers with the gecko logo. Dimensions are approximately 25” by 16” by 13”.)

If you are requesting more than your four free bags, please enclose a check for the proper amount made out to GJ CRI.

Your containers and pick up schedule will be delivered to you upon receipt of this form.

I certify that the information above is correct. I agree to participate in the curbside recycling program according to the guidelines available online. I understand that my recycling collection day (s) and set out location will be assigned and I am to have my material out by 8 a.m. for collection prior to the end of the work day.

Signed ______________________________________________

Date ________________________________________________

Signature of Resident & Date, or Signature of Owner/Manager & Date

NEWSLETTER MAILING: OPT OUT

You can now opt out of our mailings. Our newsletters( published twice each year) and your pick up schedule are available at our website, www.gjcri.com. Sign here if you would like to be removed from our paper mailing list and obtain your yearly schedules and our newsletters on-line:

Yes, take me off the snail-mail list!

Signature _____________________________________________

Yes, put me on the email newsletter notification list:

Signature _____________________________________________

MAIL THIS FORM TO:

Please mail this subscription form back to GJ CRI at the address below. Your recycling service will not begin until the form is received. Contact GJ CRI directly with any questions or comments, or if you would like to transfer or cancel curbside recycling service.

Curbside Recycling Indefinitely, Inc. (GJ CRI)

P.O. Box 2450

Grand Junction, CO 81502

(970) 242-1036