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LOS ALTOS COMMERCIAL DEBRIS BOX – EXISTING CUSTOMER
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LOS ALTOS COMMERCIAL DEBRIS BOX – EXISTING CUSTOMER
COMMERCIAL
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Commercial Debris Box Request Form – Existing Customer
Please enable JavaScript in your browser to complete this form.
-
Step
1
of 3
PO#:
Customer Name
*
First
Last
Site Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Billing Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Daytime Phone Number
*
United States +1
United States
+1
United Kingdom
+44
Afghanistan
+93
Albania
+355
Algeria
+213
American Samoa
+1
Andorra
+376
Angola
+244
Anguilla
+1
Antigua & Barbuda
+1
Argentina
+54
Armenia
+374
Aruba
+297
Ascension Island
+247
Australia
+61
Austria
+43
Azerbaijan
+994
Bahamas
+1
Bahrain
+973
Bangladesh
+880
Barbados
+1
Belarus
+375
Belgium
+32
Belize
+501
Benin
+229
Bermuda
+1
Bhutan
+975
Bolivia
+591
Bosnia & Herzegovina
+387
Botswana
+267
Brazil
+55
British Indian Ocean Territory
+246
British Virgin Islands
+1
Brunei
+673
Bulgaria
+359
Burkina Faso
+226
Burundi
+257
Cambodia
+855
Cameroon
+237
Canada
+1
Cape Verde
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic
+236
Chad
+235
Chile
+56
China
+86
Christmas Island
+61
Cocos (Keeling) Islands
+61
Colombia
+57
Comoros
+269
Congo - Brazzaville
+242
Congo - Kinshasa
+243
Cook Islands
+682
Costa Rica
+506
Croatia
+385
Cuba
+53
Curaçao
+599
Cyprus
+357
Czechia
+420
Côte d’Ivoire
+225
Denmark
+45
Djibouti
+253
Dominica
+1
Dominican Republic
+1
Ecuador
+593
Egypt
+20
El Salvador
+503
Equatorial Guinea
+240
Eritrea
+291
Estonia
+372
Eswatini
+268
Ethiopia
+251
Falkland Islands
+500
Faroe Islands
+298
Fiji
+679
Finland
+358
France
+33
French Guiana
+594
French Polynesia
+689
Gabon
+241
Gambia
+220
Georgia
+995
Germany
+49
Ghana
+233
Gibraltar
+350
Greece
+30
Greenland
+299
Grenada
+1
Guadeloupe
+590
Guam
+1
Guatemala
+502
Guernsey
+44
Guinea
+224
Guinea-Bissau
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong SAR China
+852
Hungary
+36
Iceland
+354
India
+91
Indonesia
+62
Iran
+98
Iraq
+964
Ireland
+353
Isle of Man
+44
Israel
+972
Italy
+39
Jamaica
+1
Japan
+81
Jersey
+44
Jordan
+962
Kazakhstan
+7
Kenya
+254
Kiribati
+686
Kosovo
+383
Kuwait
+965
Kyrgyzstan
+996
Laos
+856
Latvia
+371
Lebanon
+961
Lesotho
+266
Liberia
+231
Libya
+218
Liechtenstein
+423
Lithuania
+370
Luxembourg
+352
Macao SAR China
+853
Madagascar
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Martinique
+596
Mauritania
+222
Mauritius
+230
Mayotte
+262
Mexico
+52
Micronesia
+691
Moldova
+373
Monaco
+377
Mongolia
+976
Montenegro
+382
Montserrat
+1
Morocco
+212
Mozambique
+258
Myanmar (Burma)
+95
Namibia
+264
Nauru
+674
Nepal
+977
Netherlands
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger
+227
Nigeria
+234
Niue
+683
Norfolk Island
+672
North Korea
+850
North Macedonia
+389
Northern Mariana Islands
+1
Norway
+47
Oman
+968
Pakistan
+92
Palau
+680
Palestinian Territories
+970
Panama
+507
Papua New Guinea
+675
Paraguay
+595
Peru
+51
Philippines
+63
Poland
+48
Portugal
+351
Puerto Rico
+1
Qatar
+974
Romania
+40
Russia
+7
Rwanda
+250
Réunion
+262
Samoa
+685
San Marino
+378
Saudi Arabia
+966
Senegal
+221
Serbia
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Sint Maarten
+1
Slovakia
+421
Slovenia
+386
Solomon Islands
+677
Somalia
+252
South Africa
+27
South Korea
+82
South Sudan
+211
Spain
+34
Sri Lanka
+94
St. Barthélemy
+590
St. Helena
+290
St. Kitts & Nevis
+1
St. Lucia
+1
St. Martin
+590
St. Pierre & Miquelon
+508
St. Vincent & Grenadines
+1
Sudan
+249
Suriname
+597
Svalbard & Jan Mayen
+47
Sweden
+46
Switzerland
+41
Syria
+963
São Tomé & Príncipe
+239
Taiwan
+886
Tajikistan
+992
Tanzania
+255
Thailand
+66
Timor-Leste
+670
Togo
+228
Tokelau
+690
Tonga
+676
Trinidad & Tobago
+1
Tunisia
+216
Turkey
+90
Turkmenistan
+993
Turks & Caicos Islands
+1
Tuvalu
+688
U.S. Virgin Islands
+1
Uganda
+256
Ukraine
+380
United Arab Emirates
+971
United Kingdom
+44
United States
+1
Uruguay
+598
Uzbekistan
+998
Vanuatu
+678
Vatican City
+39
Venezuela
+58
Vietnam
+84
Wallis & Futuna
+681
Western Sahara
+212
Yemen
+967
Zambia
+260
Zimbabwe
+263
Åland Islands
+358
Email
*
Please check the following:
*
Residential Customer
Commercial Customer
Requested Delivery Date:
*
Requested Removal Date:
*
If this is a Green Halo project, please check this box.
Green Halo Tracking #
*
(copy)
If striving for LEED certification, please check this box.
LEED Permit#
*
Debris Box Size:
*
10 yards
15 yards
20 Yards
30 Yards
40 Yard
Material:
*
Garbage
Yard Waste/Compostable
Dirt
Concrete (NO REBAR)
Inert (Mixed Rock & Dirt Debris)
Wood
Construction & Demolition/C&D
*Recyclables
*Please note: If checked recyclables above please note Mixed or Single stream below and the material:
Place in:
*
Driveway
*Street
Other
*Note that debris boxes are not allowed in the public right of way street. Exceptions require permitting by the City of Los Altos. Proof of permit must also be submitted to MTWS with this form.
Enter name below as signature:
*
Next
Service Notes: Please initial below to acknowledge you have read and understand the service notes below.
*
SERVICE NOTES: • All debris box customers will be required to pay a pre-payment per box per pull. Pre-payment is $1,000.00 per box per pull. • Billing includes: A Per Pull Charge and Tonnage Charge for each pick up. If the debris box is not serviced within seven days, a demurrage charge will be applied each day until service is scheduled. (Fees are outlined on the attached document). • The pickup and tonnage fees are taken out of the pre-payment. If there is a balance owed, MTWS will invoice you at the end of the billing cycle. If a refund is due, a check will be sent within 30 days of last day of the billing cycle. • You may pay by company check, personal check, money order, credit card (Visa, MasterCard, & Discover) or cash (no third- party checks). This is required for each box depending upon amount of service. • Delivery and/or service times cannot be guaranteed. • Please call our of ce 48 hours before you need a delivery or pickup of the debris box. Don’t forget to include if the box is to be picked up with no return. • Please remember NO HAZARDOUS WASTE IN BOX. • Loads characterized as contaminated (i.e. trash in organics, etc) by the landfill - shall be charged at loose trash rates (Fees are outlined on the attached document). • Contaminated boxes will not return box to customer If you have any questions regarding the service, please call our office Monday through Friday 8am - 5pm at 650-473-1400.
Liability Waiver- Type name below to electronically sign
*
In consideration of the agreement of Mission Trail Waste Systems, Inc. and/or its af liates (“MTWS”) to enter onto the premises of the undersigned described below with MTWS’s vehicles and equipment to collect solid waste and/or recyclable materials, the undersigned does hereby agree to forever release and save harmless MTWS and its shareholders, of cers, directors, agents, af liates, insurers and successors from and against any and all claims, damages, actions, causes of action, costs and expenses (including attorney’s fees) relating to damage to pavement or driving surfaces on such premises which may arise in any manner out of or in connection with the entry or operation on, or egress from, such premises by MTWS’s vehicles and equipment. The undersigned also acknowledges, and waives to the maximum extent permitted by law any rights or bene ts the undersigned may have under, Section 1542 of the California Civil Code, which provides as follows: “A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.”
Site Address (where container will be located):
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Next
Credit Application
Customers are required to complete this credit application only once for life of their MTWS account.
Company/ Owner Name
*
Service Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone Number
Phone
*
United States +1
United States
+1
United Kingdom
+44
Afghanistan
+93
Albania
+355
Algeria
+213
American Samoa
+1
Andorra
+376
Angola
+244
Anguilla
+1
Antigua & Barbuda
+1
Argentina
+54
Armenia
+374
Aruba
+297
Ascension Island
+247
Australia
+61
Austria
+43
Azerbaijan
+994
Bahamas
+1
Bahrain
+973
Bangladesh
+880
Barbados
+1
Belarus
+375
Belgium
+32
Belize
+501
Benin
+229
Bermuda
+1
Bhutan
+975
Bolivia
+591
Bosnia & Herzegovina
+387
Botswana
+267
Brazil
+55
British Indian Ocean Territory
+246
British Virgin Islands
+1
Brunei
+673
Bulgaria
+359
Burkina Faso
+226
Burundi
+257
Cambodia
+855
Cameroon
+237
Canada
+1
Cape Verde
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic
+236
Chad
+235
Chile
+56
China
+86
Christmas Island
+61
Cocos (Keeling) Islands
+61
Colombia
+57
Comoros
+269
Congo - Brazzaville
+242
Congo - Kinshasa
+243
Cook Islands
+682
Costa Rica
+506
Croatia
+385
Cuba
+53
Curaçao
+599
Cyprus
+357
Czechia
+420
Côte d’Ivoire
+225
Denmark
+45
Djibouti
+253
Dominica
+1
Dominican Republic
+1
Ecuador
+593
Egypt
+20
El Salvador
+503
Equatorial Guinea
+240
Eritrea
+291
Estonia
+372
Eswatini
+268
Ethiopia
+251
Falkland Islands
+500
Faroe Islands
+298
Fiji
+679
Finland
+358
France
+33
French Guiana
+594
French Polynesia
+689
Gabon
+241
Gambia
+220
Georgia
+995
Germany
+49
Ghana
+233
Gibraltar
+350
Greece
+30
Greenland
+299
Grenada
+1
Guadeloupe
+590
Guam
+1
Guatemala
+502
Guernsey
+44
Guinea
+224
Guinea-Bissau
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong SAR China
+852
Hungary
+36
Iceland
+354
India
+91
Indonesia
+62
Iran
+98
Iraq
+964
Ireland
+353
Isle of Man
+44
Israel
+972
Italy
+39
Jamaica
+1
Japan
+81
Jersey
+44
Jordan
+962
Kazakhstan
+7
Kenya
+254
Kiribati
+686
Kosovo
+383
Kuwait
+965
Kyrgyzstan
+996
Laos
+856
Latvia
+371
Lebanon
+961
Lesotho
+266
Liberia
+231
Libya
+218
Liechtenstein
+423
Lithuania
+370
Luxembourg
+352
Macao SAR China
+853
Madagascar
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Martinique
+596
Mauritania
+222
Mauritius
+230
Mayotte
+262
Mexico
+52
Micronesia
+691
Moldova
+373
Monaco
+377
Mongolia
+976
Montenegro
+382
Montserrat
+1
Morocco
+212
Mozambique
+258
Myanmar (Burma)
+95
Namibia
+264
Nauru
+674
Nepal
+977
Netherlands
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger
+227
Nigeria
+234
Niue
+683
Norfolk Island
+672
North Korea
+850
North Macedonia
+389
Northern Mariana Islands
+1
Norway
+47
Oman
+968
Pakistan
+92
Palau
+680
Palestinian Territories
+970
Panama
+507
Papua New Guinea
+675
Paraguay
+595
Peru
+51
Philippines
+63
Poland
+48
Portugal
+351
Puerto Rico
+1
Qatar
+974
Romania
+40
Russia
+7
Rwanda
+250
Réunion
+262
Samoa
+685
San Marino
+378
Saudi Arabia
+966
Senegal
+221
Serbia
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Sint Maarten
+1
Slovakia
+421
Slovenia
+386
Solomon Islands
+677
Somalia
+252
South Africa
+27
South Korea
+82
South Sudan
+211
Spain
+34
Sri Lanka
+94
St. Barthélemy
+590
St. Helena
+290
St. Kitts & Nevis
+1
St. Lucia
+1
St. Martin
+590
St. Pierre & Miquelon
+508
St. Vincent & Grenadines
+1
Sudan
+249
Suriname
+597
Svalbard & Jan Mayen
+47
Sweden
+46
Switzerland
+41
Syria
+963
São Tomé & Príncipe
+239
Taiwan
+886
Tajikistan
+992
Tanzania
+255
Thailand
+66
Timor-Leste
+670
Togo
+228
Tokelau
+690
Tonga
+676
Trinidad & Tobago
+1
Tunisia
+216
Turkey
+90
Turkmenistan
+993
Turks & Caicos Islands
+1
Tuvalu
+688
U.S. Virgin Islands
+1
Uganda
+256
Ukraine
+380
United Arab Emirates
+971
United Kingdom
+44
United States
+1
Uruguay
+598
Uzbekistan
+998
Vanuatu
+678
Vatican City
+39
Venezuela
+58
Vietnam
+84
Wallis & Futuna
+681
Western Sahara
+212
Yemen
+967
Zambia
+260
Zimbabwe
+263
Åland Islands
+358
Email
*
Fax
United States +1
United States
+1
United Kingdom
+44
Afghanistan
+93
Albania
+355
Algeria
+213
American Samoa
+1
Andorra
+376
Angola
+244
Anguilla
+1
Antigua & Barbuda
+1
Argentina
+54
Armenia
+374
Aruba
+297
Ascension Island
+247
Australia
+61
Austria
+43
Azerbaijan
+994
Bahamas
+1
Bahrain
+973
Bangladesh
+880
Barbados
+1
Belarus
+375
Belgium
+32
Belize
+501
Benin
+229
Bermuda
+1
Bhutan
+975
Bolivia
+591
Bosnia & Herzegovina
+387
Botswana
+267
Brazil
+55
British Indian Ocean Territory
+246
British Virgin Islands
+1
Brunei
+673
Bulgaria
+359
Burkina Faso
+226
Burundi
+257
Cambodia
+855
Cameroon
+237
Canada
+1
Cape Verde
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic
+236
Chad
+235
Chile
+56
China
+86
Christmas Island
+61
Cocos (Keeling) Islands
+61
Colombia
+57
Comoros
+269
Congo - Brazzaville
+242
Congo - Kinshasa
+243
Cook Islands
+682
Costa Rica
+506
Croatia
+385
Cuba
+53
Curaçao
+599
Cyprus
+357
Czechia
+420
Côte d’Ivoire
+225
Denmark
+45
Djibouti
+253
Dominica
+1
Dominican Republic
+1
Ecuador
+593
Egypt
+20
El Salvador
+503
Equatorial Guinea
+240
Eritrea
+291
Estonia
+372
Eswatini
+268
Ethiopia
+251
Falkland Islands
+500
Faroe Islands
+298
Fiji
+679
Finland
+358
France
+33
French Guiana
+594
French Polynesia
+689
Gabon
+241
Gambia
+220
Georgia
+995
Germany
+49
Ghana
+233
Gibraltar
+350
Greece
+30
Greenland
+299
Grenada
+1
Guadeloupe
+590
Guam
+1
Guatemala
+502
Guernsey
+44
Guinea
+224
Guinea-Bissau
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong SAR China
+852
Hungary
+36
Iceland
+354
India
+91
Indonesia
+62
Iran
+98
Iraq
+964
Ireland
+353
Isle of Man
+44
Israel
+972
Italy
+39
Jamaica
+1
Japan
+81
Jersey
+44
Jordan
+962
Kazakhstan
+7
Kenya
+254
Kiribati
+686
Kosovo
+383
Kuwait
+965
Kyrgyzstan
+996
Laos
+856
Latvia
+371
Lebanon
+961
Lesotho
+266
Liberia
+231
Libya
+218
Liechtenstein
+423
Lithuania
+370
Luxembourg
+352
Macao SAR China
+853
Madagascar
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Martinique
+596
Mauritania
+222
Mauritius
+230
Mayotte
+262
Mexico
+52
Micronesia
+691
Moldova
+373
Monaco
+377
Mongolia
+976
Montenegro
+382
Montserrat
+1
Morocco
+212
Mozambique
+258
Myanmar (Burma)
+95
Namibia
+264
Nauru
+674
Nepal
+977
Netherlands
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger
+227
Nigeria
+234
Niue
+683
Norfolk Island
+672
North Korea
+850
North Macedonia
+389
Northern Mariana Islands
+1
Norway
+47
Oman
+968
Pakistan
+92
Palau
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Type of Entity:
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