NEW CUSTOMER SIGN UP

This form is for new customers registering for our services. If you have inquiries regarding our pricing, please visit our Pricing Inquires page.

 

    * First Name

     

    * Last Name

     

    * Date of Birth (MM/DD/YYYY)

     

    * Phone Number

     

    Cell/Work Number

     

    * Email Address

     

    * Mailing Address (Please include House Number, City, State, Zip code)

     

    Physical Address (if different, Please include House Number, City, State, Zip code)

     

    * Please select your county

     

    * Directions to your home

     

    * How would you like contacted?

     

    * Where do you leave your trash?

     

    If you picked other please describe your trash location.

     

    * How many bags will you dispose of each week?

     

    * Would you like a 96 gallon cart? (NO extra Charge)

     

    By clicking the “I agree” box, you acknowledge your intention to sign up for new service. You have reviewed and accepted our service policy, refund statement, and Privacy Statement. Your personal information will be used solely for the purpose of contacting you with the information you have requested.

     I agree

     

     

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