Missouri City Online Forms

2. If you are temporarily or permanently disabled and need assistance taking out your trash carts, let GFL Environmental (former WCA Waste Corp.) help you. GFL now offers a free valet/assisted service for qualified disabled customers where a professional driver will go to your residence, take out your carts to curbside, empty your carts and return them to your designated location.

4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone*
16. Email*
18. Primary Doctor's Name*
19. Doctor's Phone*

21. By typing my name below, I certify, authorize, or acknowledge: That all the information provided by me on this authorization form is accurate. Recognizing that GFL Environmental (former WCA Waste Corp.) may rely upon information I provide to make decisions on qualified valet/assisted service, I hereby certify that all information herein presented is accurate and free from intentional omission, falsification, or misleading information.

23. Signature *
24. Date*
    Date
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field