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City of Lake Saint Louis
New Customer Set-Up Form

Please fill out the form below to begin using our services.

New Customer Set-up Form

All information flagged with the red asterisk (*) must be filled out before submitting the form.

Customer Name:*   Date:*
Email Address:*   Service Address:*
City:*   Zip Code:*
Phone Number:*   Alternate Phone Number:
Billing Information if different than service address:
Billing Address:   Billing City:
Billing Zip Code:      
DL/SSN #:*   DOB:*

STANDARD SERVICE for $18.90 per month Includes:

(Senior Citizen Rate $17.00 **)

Once a week Pickup.
     Yard Waste ***
     Recycle Bin (one 18 gal bin included)*

* Please check if you plan to recycle
** Must be 62 + to qualify for Senior Rate

Ask About Optional Services Available

Additional Trash Pick Up per week $8.00 per month Yes    No
Senior Citizen Rate for 2 × PU $7.00 per month Yes    No
White Goods pick up Scheduled with Office
Bulky Items per hopper load
96 gallon Cart for Trash $2.00 each/month # of units required    
96 gallon Cart for Yard Waste*** $2.00 each/month # of units required    
Additional Recycle Bins or carts $2.00 each/month # of units required    
Recycle Bin Lids $0.50 each/month # of units required    
Container Swaps $3.00 each/time # of units required    
*** By DNR law, trash and yard waste must be separated and require separate and approved containers,. An approved container must be leak proof, fly proof and fly tight. Nothing can be outside of an approved container.



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