Garbage Bin Concierge Intake Form

Full Name*

First NameLast Name

Contact Number*

Please enter a valid phone number.

Email Address*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Service Selection*

Garbage Bin Concierge- One time $7 (up to 2 bins)Garbage Bin Concierge- Monthly Subscription $23 (No bin limit)Add-On: Garbage Bin Wash $3 each bin

How many garbage bins do you have? (Please specify)*

What day of the week is your scheduled garbage pickup? (If unsure, we can confirm with your local municipality.)*

Customer is responsible for providing accurate pickup day information unless otherwise confirmed by All Hands Company™.

Do you receive holiday or weather-related pickup delays?*

YesNoNot Sure

Where are your garbage bins normally stored?*

GarageSide of houseBackyardOther

Any Special instructions we should know?

(Gate code, locked area, specific placement request, etc.)

Agreement & Authorization (All checkboxes required to submit form)*

I confirm the information provided is accurate and that I am the property owner or an authorized representative of the property owner. I authorize All Hands Company™ to perform services at the address listed.I understand that All Hands Company™ will email my invoice and appointment details, and that service will be scheduled and activated only after payment is received. And that all sales are final unless otherwise stated.I understand All Hands Company™ is not responsible for missed pickups due to incorrect information provided.For the safety and protection of All Hands Company™ employees, I agree to secure all pets indoors and away from the service area during the scheduled service window. I understand that the services may be delayed, rescheduled or canceled if pets are not properly secured and All Hands Company™ is not liable for incidents involving unsecured pets.The Client agrees to provide reasonable access to an active water source on the premises, at no additional cost, for the purpose of completing the requested services, if applicable, including but not limited to car washing or garbage bin cleaning.

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