Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Curbside Garbage & Recycling Exemption Form

  1. INABILITY FORM - Garbage & Recycling Collection

    The City of Winston-Salem has a Mandatory Curbside Garbage and Recycling Collection Program.

    I have a physical or other limitation that prevents me from complying with the program and below is my name and address. There is no one at my home who can take the city-supplied rollout cart to the curb for collection; therefore, I request backyard collection.

  2. Type of Service

    Please select



  5. Next Step

    Your form will be stamped as received, and a copy will be returned to you. You will then receive backyard collection under the provisions of the city’s policy.

  6. Contact Information

    Tiesha Hinton, Sanitation Director
    P.O. Box 2511 Winston-Salem, NC 27102-2511

    Helen Peplowski, Sustainability Manager P.O. Box 2511 Winston-Salem, NC 27102-2511

  7. City Council Members

    CITY OF WINSTON-SALEM Mayor: Allen Joines City Council: Denise D. Adams, Mayor Pro Tempore, North Ward • Kevin Mundy, Southwest Ward • Robert C. Clark, West Ward • John C. Larson, South Ward • Jeff MacIntosh, Northwest Ward • Barbara Hanes Burke, Northeast Ward • Annette Scippio, East Ward • James Taylor Jr., Southeast Ward
    City Manager: Lee Garrity

  8. Leave This Blank:

  9. This field is not part of the form submission.