Los Altos Authorization for Automatic Bill Payment

First Name: *

First

Last

City: *

Authorized Signature *

Type your name below to digitally sign.

Authorized Signature (Optional for Joint Account) *

Type your name below to digitally sign.

Date

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email

Email

Confirm Email

Service Address (if not the same as Billing address)

Address Line 1

Address Line 2

City

State

Zip Code

Daytime Phone Number *

Email

Email

Confirm Email

Customer Name (Individual) *

First

Last

PLEASE NOTE: Because auto-pay requires a routing con rmation from your nancial institution, payments will not be processed from your account until your next billing statement. Commercial customers will be processed monthly in arrears. Residential customers will be processed quarterly in advance. Any open invoice should be paid by credit card, check or cash or your 1st autopay charge will include any open invoice plus the invoice for the current billing period. Please notify MTWS if you close your bank account or if your information changes. THERE WILL BE A RETURNED ITEM FEE FOR ANY PAYMENTS REJECTED BY OUR BANK.

I (We) authorize Mission Trail Waste Systems, Inc (Company) to initiate variable entries to my (our) account described below:

Checking Account No.

Routing Number

Financial Institution Name

Financial Institution Address:

Address Line 1

Address Line 2

City

State

Zip Code

Upload photo of voided check:

Click or drag a file to this area to upload.

PDF Forms

Start Service (collection carts present)
Start Service (need carts delivered)
On-Premise Collection (for people with physical limitations)
Stop Service
Debris Box Service (for previous debris box customers)
Debris Box Service (with credit application for first-time debris box customers)
Direct Payment Authorization Form
Authorization for Recurring Credit Card Payment

Submittal options:

Fill out the form above and submit.

Click and download the appropriate form, open in Adobe Reader, fill in, save it, and email it to us as an attachment.

Click and download the appropriate form, print it out, fill in, and mail or hand-deliver to our office.

Click and download the appropriate form, print it out, fill in, scan it in and email it to us as an attachment.

Click and download the appropriate form, print it out, fill in, and fax it to us.

PLEASE DO NOT INCLUDE CREDIT CARD INFORMATION IF EMAILING OR FAXING. IT WILL NOT BE PROCESSED.

Mission Trail Waste Systems
Attn: Billing Department
1060 Richard Ave.
Santa Clara, CA 95050
customerservice@missiontrail.com
Fax: 650-473-1300

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