San Leandro Residential Cart Service Request -

Single Family Residences and Multi-Family buildings up to 4 units

City of San Leandro Residential Cart Service Request

* = Required Information

The City of San Leandro, in compliance with the State of California and Alameda County, requires all residents to subscribe to IWM collection services to ensure environmental justice and protect public health.

If you are unable to complete or submit this form, please call us at 510-357-7282.

PLEASE NOTE! THIS FORM IS FOR THE CITY OF SAN LEANDRO SERVICE ONLY. ARE YOU USING THE CORRECT SERVICE AREA FORM?

YES - MY SERVICE ADDRESS IS IN THE CITY OF SAN LEANDRO. *

I acknowledge the above statement (please check box to continue).

If you need to request services for a location in another one of our collection areas, please DO NOT USE this form. Please select the correct area below.

Unsure which service area is yours? CONTACT US

ALAMEDA CVSAN SAN RAMON

Which residential service are you requesting? *

Single Family Resident - Carts at site
Single Family Resident - Carts to be delivered
Multi-Family Resident (buildings up to 4 units*) - Carts at site
Multi-Family Resident (buildings up to 4 units*) - Carts to be delivered

*Multi-Family buildings with more than 5+ units require a Multi-Family bin service form.

Start service date: *

Service address (CITY OF SAN LEANDRO ONLY): *

Address Line 1

City

State

Zip Code

PLEASE NOTE! THIS FORM IS FOR THE CITY OF SAN LEANDRO SERVICE ONLY. If you need to request services for a location in another one of our collection areas, please DO NOT USE this form. Please select the correct area below.

Unsure which service area is yours? CONTACT US

ALAMEDA CVSAN SAN RAMON

Mailing / billing address - if different from service address:

Address Line 1

Address Line 2

City

State

Zip Code

Name(s) on account (Only these names may authorize changes to account): *

First

Last

Name(s) on account (Only these names may authorize changes to account):

First

Last

Name(s) on account (Only these names may authorize changes to account):

First

Last

Please supply at least one phone number: (work)

Please supply at least one phone number: (home)

Please supply at least one phone number: (cell)

Email *

Do you own or rent the property that you are starting service for?: *

Own
Rent

Deposit: ACI requires a deposit equal to 3 months (1-quarter) of service fees for all customers. The deposit will be applied to your final bill.

If you previously had service with us, please list your previous San Leandro address:

Address Line 1

City

State

Zip Code

Note: A stop service application must be completed to stop service at this address or the account will remain active. *

I acknowledge the above statement (please check box to continue).

Garbage collection cart size at the service location: *

Garbage collection cart size would you like to have delivered: *

Click here for garbage cart sizes/dimensions.

Recyclables and Organics are included in the basic collection service prices. The standard sizes delivered with the garbage carts are a 64-gallon recyclables cart and a 64-gallon organics cart. If you would prefer a smaller (32-gallon) or larger (96-gallon) cart for recyclables or organics, please indicate below or request to have a customer service representative will call you and discuss the size available.

Deliver a 64-gallon recyclables cart and a 96-gallon organics cart
Please have customer service call me to discuss sizes available

Phone number:

An on-premise backyard collection service is available for an additional fee. The on-premise service is free of charge for residents issuing proof of a physical inability to transport their carts. A form is required to qualify. Please contact us for details.

I have read the rate sheet / misc. rate sheet and acknowledge the rate for this service. I understand that service cannot begin without acknowledgment of the applicable service rate. *

I acknowledge the above statement (please check box to continue).

Click here for Rate of Service

There is a charge to change your service level more than once in a twelve-month period - please call our office for fee information. PLEASE NOTE: delivery, repair, or replacement of carts shall be provided on the Customer's next regular collection/service date. *

I acknowledge the above statement (please check box to continue).

Form of payment for deposit: *

Mail check to office (610 Aladdin Avenue, San Leandro, CA 94577)
Pay by credit card (VIsa, American Express, MasterCard or Discover)

Phone number for customer service to call for credit card number:

The credit card will charged for the 3-month service deposit. It will NOT be charged for ongoing fees. DO NOT include credit card information with this form. Any forms received with credit card information will immediately be deleted and the application will not be processed. *

I acknowledge the above statement (please check box to continue).

By having services and/or an account with ACI, you agree to our General Information, Terms, and Conditions. *

I acknowledge the above statement (please check box to continue).

Click here for our General Information, Terms, and Conditions.

Signature *

Clear Signature

Submission of this form must include a signature.

Additional comment / questions: