Cleaning Liberia Logistics
Hill Top Community, Bardnersville Township
info@cllinc.org
www.cllinc.org
Cell: +231-770-444-101
+231-886-807-140
+1-407-552-9565
New Customer Registration Form
Customer Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Type of service(s) requesting
Select your service areas
Area One - Duazon/Boys Town
Area Two - ELWA junction
Area Three - Jamaica Road
Area Four - Red-Light to Omega Community
Other areas
Community ( Please describe your community clearly)
*
Describe your type of business
Number of times per-week
1 - Time
2 - Times
3 - Times
4 - Times
More
Days Service Is requested
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Type Of Waste
*
Please Select
Organic Waste
Industrial Waste
Electronic Waste
Hazardous Waste
Demolition Waste
Community Waste
Please Specify if Other not listed
*
Any specific instruction or information needed to make our task safe,easy and undelayed
How did you hear about us
*
Please Select
Newspaper
Internet
Magazine
Radio/TV
Person-to-Person
Poster/Flyer
Other
Please Specify
*
Will you be willing to recommend us?
Yes
No
Maybe
Please give reference of any two people whom you feel: would need our services
Rows
Full Name
Address
Contact Number
Email
1
2
3
Customer Signature
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