“To be a financially sound City providing top quality municipal services
while focusing on the customer and engaging our community.”
City of Winchester Telephone: (540) 667-1815
City Yards FAX: (540) 662-4627
301 E. Cork Website: www.winchesterva.gov
Winchester, VA 22601
REQUEST FOR LARGE-ITEM COLLECTION
NAME __________________________________________________________
ADDRESS __________________________________________________________
__________________________________________________________
PHONE ___________________________ TODAY’S DATE ________________
DATE FOR REQUESTED COLLECTION ______________________________
(Requested date must be a Monday or Tuesday)
Please read the attached information sheet carefully to be sure that your items are acceptable for
collection. Collections will be scheduled on a space-available basis on Mondays and Tuesdays only.
Every effort will be made to collect on the date requested, however we reserve the right to adjust
appointments due to scheduling needs. Staff will contact you to confirm/adjust the collection date. Do not
place your items out prior to the evening before this CONFIRMED collection date. If your items are
already curbside prior to scheduling, they must be removed immediately.
Please list items for collection:
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
Fee Schedule (must be prepaid):
Large-Item Collection (per pickup truck load) ..……………………………………………..………… $20.00
Estimated number of pickup truck loads needed …………………………………………………….. x ______
Number of electronics or freon containing appliances (additional fee*) ….…….………………….. + ______
*Contact Michael Neese for associated fees at (540) 667-1815, ext. 1452 Total = ______
or michael.neese@winchesterva.gov
Return this form with payment by mail or in person to:
City of Winchester Please make checks payable to: City of Winchester
City Yards
301 E. Cork St. Do NOT mail cash
Winchester, VA 22601
OFFICE USE ONLY
Date Received __________________ Date Scheduled for Pick-Up:___________________
Amount Received __________________ Confirmed: _______________________
___ Money Order ________ ___ Check (#________) ___ Other ___________ Received by: _____________________
