Application OR
Renewal
(Print
out or email/mail this information)
For
Trash Pick Up
and/or
For
LEAPO Membership
Billing
Name_______________________________________________________________
911 Designated Pickup
Address_____________________________________________________________
Rent
_____________
Own _____________
City, State
Zip_________________________________________________________________
Billing
Address____________________________________________________________
City, State
Zip________________________________________________________________
Subdivision and Lot
information__________________________________________________________
Local Phone
Number__________________________
Permanent Phone
Number_____________________________
If you wish to receive information and updates
from LEAPO please include your email address:
______________________________________________________________________________________
You must be a member of
LEAPO to participate in the Trash Program
Check Applicable
Lines
Fill in amount
______I am presently a member of
LEAPO.
______Enclosed is my yearly LEAPO
membership of $ 24.00 ________________
______Enclosed is my $ 29.00
quarterly TRASH payment ___________
______Enclosed is my $ 113.00 YEARLY TRASH payment
____________
Allow one week for registration. You may
call the listed 800 number to verify pick up day.
You may call 618-995-2629 with any billing questions.
TOTAL
ENCLOSED ___________
Make check payable to: LEAPO
Mail to: LEAPO, POB 127, Goreville, IL
62939
If
you wish to take advantage of a yearly discount, please pay $113 for Trash
service and $24 for your Dues. Thank you.