Quick-Pay Bill Pay DB Form Pure HTML/CSS

Quick-Pay

Pay Your Current Trash Bill Now By Filling Out This Form
If service has been discontinued due to a past due balance, call the office immediately to have service reactivated.

If payment is submitted online, we cannot guarantee that your service will be restored by your regular pickup day.
Terms and Conditions*

I agree to terms and conditions
Link to Terms & Conditions
Enter Your Disposal Company as it appears on your bill.*

Bolivar DisposalBubba DisposalDB Disposal
Terms and Conditions*
Your Email*
example@example.com
Does your account number contain a dash ? (ex:0004177-1 or JL0001234-1)*

NoYes
Customer Account Number*
Enter your Customer Account Number exactly as it appears on your mail-in bill.
Enter number after dash *
enter only the number that appears after the dash in your account number. ex: -1
Enter Amount Due on Your Bill:*
Customer_Account_Number_for_Access
Conv. Fee + Amount Due Calculation
'

Your Total Amount Due + Convenience Fee($2.25):

USDWe charge a $2.25 Convenience Fee which is automatically added to your bill.