Rolloff New Customer Service Agreement | Western Kane County Special Services District

Name*

First

Last
Business Name (Optional)
Billing Address*

Street Address

Address Line 2

City

State

ZIP Code
Dumpster Address*

Street Address

Address Line 2

City

State

ZIP Code
Phone*
Email*
I wish to receive my bill via email?*
- Yes
- No
What Size Dumpster?*
- 20 Yd
- 30 Yd
I hear by agree to pay $75.00 per calendar month per dumpster for the rental of my dumpster(s), $275.00 (30yd) or $225.00 (20yd) for each lift that I incur and $85.00 for delivery of dumpster. I understand I will be invoiced monthly for these services and that my payment is due within 30 days of the invoice date. If paid after that date, there will be a 18% late fee assessed at a minimum of $5.00 per month. If payment is received more than 60 days after the invoice date WKCSSD will no longer empty up my dumpster(s). If payment has not been received before 90 days after invoice date WKCSSD will remove all dumpster(s) at my expense and I will incur a $100 replacement fee per dumpster for them to be returned.
There is a $100 per empty mileage surchage for dumpsters placed 15+ miles from the nearest landfill. There is a $125 non-use fee for rolloffs not emptied within a calendar month.
Digital Signature*

Please type your name agreeing to the above.