Please complete the application below to reserve your bin for delivery. <form-template> <fields> <field type="text" subtype="text" required="true" label="First Name" class="form-control text-input" name="text-1647451239164"></field> <field type="text" subtype="text" required="true" label="Last Name" class="form-control text-input" name="text-1647451263472"></field> <field type="text" subtype="text" required="true" label="Address - House Number" description="Please provide the house number for your street address within the City of Dauphin" class="form-control text-input" name="text-1647451275020"></field> <field type="text" subtype="text" required="true" label="Phone" class="form-control text-input" name="text-1647451295138"></field> <field type="text" subtype="text" required="true" label="Email" class="form-control text-input" name="text-1647451309082"></field> <field type="select" required="true" label="I am a" description="Please choose one" class="form-control select" name="select-1647451329594"> <option value="Homeowner" selected="true">Homeowner</option> <option value="Tenant">Tenant</option> <option value="Business">Business</option> </field> <field type="checkbox-group" required="true" label="Email Notifications" description="Do you wish to receive City of Dauphin Important Notifications by email?" class="checkbox-group" name="checkbox-group-1647451405070"> <option value="Yes" selected="true">Yes</option> <option value="No">No</option> </field> </fields> </form-template> Submit Submitting...