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LOS ALTOS DEBRIS BOX NEW CUSTOMER WITH CREDIT APPLICATION
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LOS ALTOS DEBRIS BOX NEW CUSTOMER WITH CREDIT APPLICATION
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Los Altos Debris Box Application
Please enable JavaScript in your browser to complete this form.
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
*
Email
*
Please check the following:
*
Residential Customer
Commercial Customer
Requested Delivery Date:
*
Requested Removal Date:
*
If striving for LEED certification, please check this box.
LEED Permit#
*
Debris Box Size:
*
10 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:
*
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
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
*
Email
*
Fax
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
Billing Phone
*
Billing Cell Phone Number
Billing Email
*
Billing Fax
Type of Entity:
Corporate
Sole Proprietor/Owner
Partnership
Submit