Request for Replacement or Additional Blue Recycling Box

Items marked must be completed

Use Of The Form

	Form Ref. No.		603119

	This form can be completed on-line. When completed it should be submitted electronically back to the Council.

	If you are going onto the new wheeled bin service : - you will not be able to order new or replacement blue boxes after 14th February 2008, and - you will not need blue boxes for your recycling once you have your new wheelie bins.
	Only use this form if you live in one of the following roads in Shoreham town centre : - Brighton Road (nos. 368-410) - Brunswick Road - Church Street - East Street - Ham Road - High Street - John Street - Middle Street - New Road - North Street - Pond Road - Queens Place - Ship Street - St Marys Road - Surry Road - Tarmount Lane - West Street (1-73, and 2-56) - Western Road - Willowbrook Park, Old Salts Farm Road, Lancing (over the bridge) If you do not live in one of the streets listed above then please exit this form and order a recycling wheelie bin, not a blue box.

Your Details

	Name
	Telephone Number (Day time)
	Email Address
	Street (Please enter the first letter of the street name and then click 'Lookup Street')

	Area
	House Name/Number

Boxes Required

	How many boxes do you require
	Is this your first, a replacement, or an additional box?
	The box(es) will normally be delivered as soon as possible in the next few weeks.

Return the Form


	Click here to return the form electronically. A printable version will be provided for your own records.