Online Bulk Pickup Request
Welcome to Rockville Centre's Bulk Pickup Request online form.
Bulk pickup request:
Name:
Address:
Phone Number:
Items:
Email Address:
Confirm Email Address:
An electronic signature is a certification by you that may be used in lieu of a written signature. By clicking the [Submit..] button below, you are electronically certifying this document as you would physically sign if it were on paper.
Press the submit button below only once.
