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4. Instructions

   This pilot program is to test if a larger, 35-gallon blue cart (like a smaller version of a 96-gallon rolling trash cart with a lid and wheels) will be well received by residents and will generate more, clean blue bin recyclables.

   Interested? Here are the parameters:

   • You must live in unincorporated Palm Beach County and have curbside garbage collection service
   • There is a $15 fee to join the pilot program,  cash only
   • All participants will need to fill out a pre- and post-use survey to help measure the use and effectiveness of the carts
   • You must come to the SWA to pay the fee, complete the pre-use survey, and pick up your new recycle cart
   • You must be willing to take the post-use survey after 6 months of use
   • You must report damage, maintenance or repair needs to the SWA in a timely manner so the cart can be serviceable

     Thank you for helping to Recycle Right in Palm Beach County.

6. First Name*
7. Last Name*
9. Address (House Number and Street Name)*
11. City*
12. Zip*
14. Telephone*
    If no telephone, enter 555-555-1234.
15. Extension
17. Email Address
    If you would prefer a response to your questions by email, please enter to address here.
18. Please add me to the SWA's monthly eNewsletter, Waste Matters.*

    1. Yes

    1. No
20. Community Name (Subdivision / Development)
21. I currently have:

    1. 1 18-gallon blue recycling bin
    2. 1 25-gallon blue recycling bin
    3. A combination of 18- and 25-gallon blue recycling bins
    4. I don't recycle but want the cart
23. Use of 35-Gallon Cart*

    I understand that this 35-Gallon Blue Recycling Cart is to be used for only blue recycle bin materials such as plastic, metal and glass food containers less than 2 gallons.

    1. Yes
    2. No
24. I live in:*

    1. Unincorporated PBC
    2. Within a municipal limits
    3. Do not know
26. Pickup Window Date/Time (M-F 8am-5pm)
    Pickup Window Date/Time (M-F 8am-5pm)

    Pickup Window Date/Time (M-F 8am-5pm)

    Please let us know when you would be available to pick up the 35-gallon cart from our office at:

    7501 North Jog Road, West Palm Beach, FL 33412

    Please note this is not a final scheduled date/time. We will contact you to confirm.

28. How did you hear about this program?*

    (Click all that apply.)

    1. Event
    2. Nextdoor App
    3. Website

    1. Neighbor/Friend
    2. Social Media
    3. Other
30. Comments
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field