Rubbish and recycling assisted collections - Expression of interest form

Any resident who is unable to move their wheelie bin to the edge of their property because they are either elderly or infirm, can ask for an ASSISTED COLLECTION. The wheelie bin will be collected from OUTSIDE the front door instead of the edge of the property.

Please use this form to register an interest in signing up for assisted collections for rubbish or recycling. Once you have completed the form a member of staff will contact you to discuss your requirements and advise you on how to register.

To find out how the information on this e-form will be used, please read our Privacy Policy: http://www.spelthorne.gov.uk/ly_eforms_privacy_policy.htm

Date

Name of contact ^*

Telephone number of contact

Name of person requiring an assisted collection ^*

Address of person requiring assisted collection





County
Postcode

Contact telephone number ^*

Please use this space for any other information which might be useful