GMWSS - Service Requests or Issues
* Service Request:
Choose one
Service Issue
Disconnect Existing Service
Update Mailing Address
ACH Payment Termination
Other
Please select the type of Service required.
* Customer Full Name:
* Service Address:
* GMWSS Account Number:
* Email Address:
* Phone Number:
123-123-1234
* Requested Service Stop Date:
mm/dd/yy
* Final Billing Address
* New Mailing Address:
* Comments or Questions: (Please do not include any apostrophes ( ' s ) to avoid errors).
Please note: Questions or Comments regarding garbage collection should be directed to Republic Services at 502.209.3800.
* Last Four Digits of Social Security Number
Please enter the last four digits of your Social Security Number for Validation.
Signature:
Typing your Full Name above signifies your agreement with all terms of service.
Typing your Full Name below signifies your agreement with all terms of service.
Clear