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2. City of Jacksonville, Arkansas

3. This form is to request bulky item(s) pick up.  Piles 2 cubic yards and smaller will be picked up automatically on regular trash day.  Piles over 2 cubic yards will be assessed a value and require payment with Public Works prior to pick up.

5. Date
   Date

   Date
7. First Name
8. Last Name
10. Address1
12. Address2
14. City
15. Arkansas
16. Zip*
18. Description of Landfill Items
20. Other than Jacksonville, Arkansas
    Please notify proper organization.
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field