* Boro: 

Select a boro... The Bronx Brooklyn Manhattan Queens Staten Island

* Street Address: 

* Between Streets: 

* Is the address a multi-dwelling residence? 
(three or more families) 

   Yes No

* Special Location Instructions: 

* Are the materials still at the above location? 

   Yes No

Additional Questions

* What is the date of the missed collection? 

Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

* Was this your recycling collection day? 

   Yes No

You may check your Collection Schedule. 

* Was your collection day a holiday? 

   Yes No

You may check your Holiday Collection Schedule. 

* Were the materials placed curbside between 5pm (4pm on Fridays - October through April) and midnight of the previous night? 

   Yes No

* Were the materials appropriately packaged? 

   Yes No

Additional Information: 
e.g. # of bags of metal/glass/plastic recyclables 
(maximum 100 characters) 

If necessary, how can we contact you?

* Name: 

* Daytime Telephone Number including Area Code: 

* E-mail Address: