DAMAGED CAN REQUEST FORM
Please fill out a separate form for EACH can in need of service.

**IMPORTANT INFORMATION**
  • THE TOWNSHIP OF LAKEWOOD does not repair or replace cans damaged by animals (SQUIRREL HOLES) if you wish to have your animal damaged can replaced, please fill out the Additional Can Request Form to purchase a replacement can. 
  • THE TOWNSHIP OF LAKEWOOD does not cover lost, stolen, or missing cans, you must visit the Additional Can Request Form to purchase a replacement can.
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電子郵件 *
Name *
Phone number *
Address *
House Number
Address *
Street Name
What day of the week is you garbage collected? *
What color is your damaged can? *
What is the damaged can number? *
What kind of damage? (check all that apply) *
必填
Additional comments.
I agree to the following: *
必填
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