Roll Off Service Agreement & Liability Waiver
Please complete the information below and review the terms of this agreement prior to dumpster delivery.
DELIVERY INFORMATION
Customer Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BILLING INFORMATION
Please make sure this information will match the credit card details provided at the time of booking.
Name on Credit Card
*
First Name
Last Name
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dumpster Size
*
Please Select
6 Yard Dumpster (6.5-7' Long x 7.5' Wide x 4' Walls)
12 Yard Dumpster (12' Long x 8' Wide x 5' Walls)
20 Yard Dumpster (22' Long x 8' Wide x 4' Walls)
30 Yard Dumpster (22' Long x 8' Wide x 6' Walls)
Preferred Delivery Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Dumpster Placement Instructions
In Driveway
Parking Lot
Street (Parking Permit Required if Applicable)
Marker will be left marking location (cone, folding chair, etc.)
Other
Customer ACKNOWLEDGEMENTS
*
I understand Santaguida Sanitation does not provide plywood or wood protection boards. If driveway protection is desired, plywood must be on site at the time of delivery or left in the exact location where the dumpster is to be placed.
I understand Santaguida Sanitation is not responsible for damage to driveways, lawns, sidewalks, curbing, irrigation systems, underground utilities, or other surfaces while delivering, servicing, or removing a dumpster.
I understand dumpsters may not be loaded above the top edge and prohibited materials including paint, tires, propane tanks, hazardous waste, batteries, flammable liquids, and drums are not permitted. Additional charges may apply for overweight containers, prohibited items, or improperly loaded containers.
I understand that blocked containers, inaccessible placement locations, or failed delivery or pickup attempts may result in a trip charge.
*
By signing below, I acknowledge that I have read, understand, and agree to the terms of this Roll Off Service Agreement and Liability Waiver.
Sign Agreement
*
Print
Submit Signed Agreement
Submit Signed Agreement
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