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)
My Products
*
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( X )
One Time Clean
$40 1st can, $20 per additional can
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment 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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