Application for Organic Waste Collection Services (*) Marks a required field.Today's Date* MM slash DD slash YYYY Name* First Last Email* Business Name* Business License Number* How many organics containers would you like to receive?*Each tote is a 35-gallon container. The first container will cost $31.23 and each additional container will cost $28.94. Charges will be made on a monthly basis and added to your current utility bill. Billing Address* Street Address City ZIP Code Is your delivery address the same as the billing address?*YesNoDelivery Address* Street Address City ZIP Code Primary Phone Number*Secondary Phone NumberPlease note: In some cases, please allow at least two (2) business days for processing of container requests. The undersigned (customer) agrees to the following terms and conditions. Please place a checkbox next to each statement showing that you have read, understood, and agreed with the statement.The undersigned (customer) agrees to:* Be responsible for any damages to the container(s) and to personal and public property for the duration of the lease. Return the container(s) in a satisfactory condition. Pay a fee of $31.23 for the initial container and $28.24 for each additional container. New charges being added to the monthly utility bill. Keep containers on private property at no additional cost. Customer Electronic Signature (please type your full name)* PhoneThis field is for validation purposes and should be left unchanged.
