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LOS ALTOS COMMERCIAL START BIN SERVICE
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Commercial Start Bin Service Form
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Requested Delivery Date
Account Number:
Customer Name:
*
First
Last
Site Address:
Address Line 1
Address Line 2
City
--- Select state ---
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Zip Code
Phone
*
Email
*
Email
Confirm Email
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
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
BIN COLLECTION SERVICE - 1YD - 8YD (Please check appropriate box. Customer service representative will fill in rate.):
Commercial Garbage Service
Commingled Recyclables Service
Bin Size:
To be serviced how many times per week?
Note that recyclables and organics collection service will be provided for no additional charge to multi-family residential complexes with adequate trash service. For every 4 living units, you are entitled to weekly service of 96-gallons of recyclables and 96-gallons of organics. If recyclables and organics service is not already in place, we invite you to contact us today and get started.
CART COLLECTION SERVICE - 32-GALLON - 96 GALLON (check appropriate box):
Commercial Garbage Service
Commingled Recyclables Service
Organics (food/yard waste) Service
Cart Size:
To be serviced how many times per week?
Signature: (Type your name below to authorize)
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
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
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
Phone
*
Fax Number:
Email
*
Email
Confirm Email
Type of Entity:
Corporate
Sole Proprietor/Owner
Partnership
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