Temporary New Customer Service Agreement

Name*
First Last
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 type of address is this?*
- Residential
- Commercial
This is for a 6yd Temporary Dumpster.
I hear by agree to pay $20 per month per dumpster for the rental of my dumpster and $30 for each lift requested. If the dumpster is not emptied at least once per calendar month, a $30 non-use fee will be charged. 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.
Digital Signature*

Please type your name agreeing to the above.