Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your billing address different than your home address?
*
No
Yes
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Garbage Collection Day - cleaning will take place on the same day as your garbage collection. Most waste haulers collect 2 days per week. Cleaning will be done on one of those days.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Help us make sure we clean the right cans! Color of Cans/ Where are they kept / Any other notes you think would be relevant for us
*
How did you hear about us?
*
Direct Mail
Saw the Truck
Instagram
Facebook
Word of Mouth
Hanger
Google
TAPinto
That Westfield Podcast
Golf Course Guide
Other
Referral (if applicable)
Options
*
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( X )
Monthly - 1 Can
Service and Billing once per month ($15)
$
15.00
for each
month
Monthly - 2 Cans
$15 first can + $7 each additional can. Service and Billing once per month ($22)
$
22.00
for each
month
Monthly - 3 Cans
$15 first can + $7 each additional can. Service and Billing once per month ($29)
$
29.00
for each
month
Monthly - 4 Cans
$15 first can + $7 each additional can. Service and Billing once per month ($36)
$
36.00
for each
month
Monthly - 5 Cans
$15 first can + $7 each additional can. Service and Billing one per month ($43)
$
43.00
for each
month
Monthly - 6 Cans
$15 first can + $7 each additional can. Service and Billing one per month ($50)
$
50.00
for each
month
Monthly - 7 Cans
$15 first can + $7 each additional can. Service and Billing one per month ($57)
$
57.00
for each
month
Monthly - 8 Cans
$15 first can + $7 each additional can. Service and Billing one per month ($64)
$
64.00
for each
month
Monthly - 9 Cans
$15 first can + $7 each additional can. Service and Billing one per month ($71)
$
71.00
for each
month
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
You have selected multiple cans, will any of those cans be recycling?
*
Yes
No
Not applicable
Recycling Collection Day - cleaning will take place on the same day. We are aware most towns have set schedules every other week.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Submit
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