2. Instructions
   Special curbside pickup of bulky items is available upon request for all City residences eligible for curbside trash and recycling services. The charge for items picked up will be added to your utility bill.
   
   Please complete and submit the form below to request a special garbage pickup. A staff member will contact you to confirm your inquiry and pickup date. For more information, contact Streets and Solid Waste at 319.248.1740.
4. Before Completing This Form
   Do not send usable items to the landfill.
6. Iowa Valley Habitat for Humanity ReStore (2401 Scott Boulevard SE, Iowa City) accepts usable shelving, appliances, building and plumbing supplies, hardware, tools, cabinets, furniture, lighting, doors, windows, tile, and flooring. New/gently used mattresses and box springs are donated to the Houses into Homes program. Free pickup is available. Donations are tax-deductible.
   If you would like to donate your items to ReStore, schedule a free pickup at www.iowacityrestore.com or call 319.338.5687.
8. Houses Into Homes provides new or gently used furniture, including mattresses and box springs, to families who are exiting homelessness, domestic violence, and other crisis situations. Free pickup is available. Donations are tax-deductible.
   If you would like to donate your items to Houses into Homes, request a free pickup at www.housesintohomes.org.
10. If you would like the City of Coralville to pick up and dispose of your items, please complete this form.
14. Contact Information
16. First Name*
17. Last Name*
19. Pickup Street Address in Coralville, IA*
21. Please confirm my request via:*
    -- Select One --EmailPhone
23. Email address*
24. Phone (day/cell)*
28. Item(s) to be Picked Up
30. Appliances & Electronics

    Picked up by request on the last consecutive Thursday and Friday of the month. Requests must be received and confirmed by Tuesday prior to pickup up.

    1. DVD, VCR, or laser/inkjet printer ...$ 6
    2. Computer monitor ...$18
    3. Computer, keyboard, and tower ...$18
    4. TV ...$18
    5. Appliances: Air conditioner, dehumidifier, dishwaster, dryer, microwave, refrigerator, stove, washer, water heater, etc. ...$18
32. Quantity of DVD/VCR, or laser/inkjet printer(s)
34. Quantity of computer monitor(s)
36. Quantity of computer(s), keyboard(s), and tower(s)
38. Quantity of TVs
40. Quantity and type of appliance(s)
42. Tires

    Picked up by request on the last consecutive Thursday and Friday of the month. Requests must be received and confirmed by Tuesday prior to pickup.

    1. Car tires (no rim) ...$ 5
    2. Car tires (with rim) ...$ 7
44. Other Item(s)

    Picked up by request at no charge. Requests for pickup of items not listed above must be received and confirmed by 3:00 pm weekdays to be picked up on the next pickup date. Pickups occur twice each week.

    1. Other item(s). Charges may apply.
46. If you checked "Other item(s)," please list items and quantities to be picked up.
48. Agreement
    By submitting this request, I agree to pay any applicable fee(s) associated with special garbage pickups. I also acknowledge that the pickup schedule may be altered due to weather or City holidays.
50. Additional Comments
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field