Sign-Up For ServiceCustomer Name* First Last Service Address* Street Address Type of Service: Residential House Residential Apartment Commercial Apartment Commercial Business 3 YD Dumpster RentalResidential House:- $71.04/Qtr (1 brown trash can & 1 blue recycling cart)- $33.42/Qtr (1 compost can)Residential Apartment:-$71.04/Qtr (1 brown trash can & 1 blue recycling cart)- $33.42/Qtr (1 compost can)-$329.94/Qtr (3 YD dumpster)Commercial Apartment/Businesses:-$110.22/Qtr (1 brown trash can & 1 blue recycling cart)- $59.13/Qtr (1 compost can)-$461.94/Qtr (3 YD dumpster)-3 YD Dumpster Rental - One Month$109.98-Residental$153.98-CommercialAdditional Services:-Extra brown can:(+$33.99/Qtr Residential)(+$97.38/Qtr Commercial)-Replacement Can Fee- $50 fee for each cart lost, stolen, or damaged.-Bulk Item Pickups- 2 free per year. ($50 each additional pickup)-3 YD Dumpster Rental - One Month$109.98-Residental $153.98-CommercialPrice Agreement* I agree to the prices above for the services I selected.Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Number of Tan Trash Bins Needed*Number of Blue Recycling Bins Needed (max 1)*Please enter a number from 0 to 1.Number of Green Compost Bins Needed**If you choose to not take a compost can, please fill out the Self-haul waiver application form on our homepage. Review the requirements of being a self-hauler thoroughly as there is some reporting requirements you must follow. **ONLY FILL OUT FORM IF NOT REQUESTING A COMPOST BIN**Self-Haul Waiver Application FormNumber of Dumpsters Needed*Service Start Date* MM slash DD slash YYYY Terms and Conditions*The customer agrees to pay in a quarterly billing cycle. An invoice will be sent for the current quarter once carts are delivered, or once service starts (prorated fees apply). Invoices not paid within 30 days are past due. If payment is not received by the 60th day, services will be discontinued. I agree to the above terms and conditions. For additional information, call 661-832-2635
