Skip to Main Content
Loading
Loading
About Rockville
City Government
City Projects
Services
Form Center
Form Center
Welcome to the City of Rockville Form Center. If your form requires a response, we will contact you as soon as possible.
Search Forms:
Search Forms
Select a Category
All Categories
City Clerk
City Manager
Claims
Code Enforcement
Community Planning and Development Services
Finance
Housing and Community Development
Human Resources
I-Rock
Police
Public Works
Recreation and Parks
Report a Concern
Volunteering
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Apply for Backdoor Recycling and Refuse Service
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Address or Location of Pick Up
*
Agreement
I am requesting that the City of Rockville provide me with backdoor service, at no additional charge, for my recycling and refuse collections. I am unable to transport my carts to the curb or alleyway and there is no one in my household who is able to transport them for me.
I understand that it is necessary to reapply for this service each year. I also understand this service is based on my inability to take my recycling and refuse carts to the curb or alleyway.
First Name
*
Last Name
*
Phone Number
*
Email
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Departments
Volunteer
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow