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2. Name of company placing dumpster*
4. Address of company placing dumpster*
6. City*
7. State*
8. Zip Code*
10. Phone Number of company placing dumpster*
12. Address where dumpster will be located*
14. City*
15. State*
16. Zip Code*
18. By checking this box I indicate that I understand that I am requesting a permit to place a dumpster greater than 6 yards in the town of Agawam. I also am aware that I must comply with all state and local codes and ordinances in the placement of this dumpster.*

    1. I understand
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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