EnviroWaste Registration Form

Full Name*

First NameLast Name

E-mail*

Enter your Zip Code*

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Service Address*

Location of trash pickup

City*

State*

Zip*

Service?

Service Confirmation

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Phone 1 Type*

Cell Phone is preferred and much needed! We communicate primarily via text. You will miss out on timely announcements if landline or VOIP is provided.

Phone 1*

Phone 2 Type

Optional

Phone 2

Optional

Preferred Bill Delivery*

EmailPaperEmail+ Paper

Service start date

Set this to the first day in the week of which you would like service to begin

Service Type*

Residential curbside pickupCommercial dumpster

NOTE: Envirowaste charges a one-time trash can delivery fee of $10

Expected Use for Dumpster (check all that apply)*

NOTE ON DUMPSTERS

NOTE: ENVIROWASTE charges a $125 delivery charge for dumpsters.

As a small company we do not maintain a large inventory of dumpsters on hand. Therefore, dumpsters are not always immediately available.

We appreciate your patience and understanding as we grow our business.

Billing address is*

SameDifferent

Billing Street Address

Billing City

Billing State

Billing Zip

How did you hear about us?*

Select one or more.

Referred By

First NameLast Name

Comments/Detailed Instructions

Help us locate you and your trash can! Let us know where your house number is. House, Mailbox, etc. Dumpsters require DETAILED location info.

Start Service Initial Payment*

Residential Service$85.00

Service Type
Item subtotal:$0.00

2 yard dumpster$270.00

Pickup frequency

4 yard dumpster$340.00

Pickup frequency

Enter coupon

Subtotal $0.00Shipping $0.00Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

The last empty box is for the billing zip code for your payment card

PLEASE NOTE: This form is for NEW customers ONLY!

For existing customers, do NOT attempt to make a payment via this form. Please go to trashbilling.com to pay your bill. Or call us at 330-525-7500

SERVICE TYPE/SIZE	FOR WEEKLY SERVICE	FOR BI-WEEKLY PICKUP
Basic Service - Includes container	$85.00 Per Quarter	n/a
2 yard dumpster	$270.00 Per Quarter	$240.00 Per Quarter
4 yard dumpster	$340.00 Per Quarter	$310.00 Per Quarter

Prices Effective 7/1/2024

SATISFIED customers love ENVIROWASTE

NO contracts
NO maddening automatic renewals
NO hassles
NO bureaucracy
NO taxes or surcharges

ENVIROWASTE is everything the BIG GUYS are not

Locally owned
Family owners/operators
Environmentally responsible
Friendly and personal service

Preferred Ongoing Payment Method

Auto draft ACH from bank accountAuto pay via credit cardCheck or cashOther

I agree to receive occasional text messages regarding my account, route changes or delays, and general communications from Envirowaste Services LLC at the number I provided. Msg & data rates may apply. Reply STOP to no longer receive messages

YesNo

We currently serve customers in and around the following communities:

Alliance, Beloit, Damascus, East Canton, East Rochester, Homeworth, Louisville, Marlboro, Maximo, Minerva, North Georgetown, North Lima, Paris, Salem, Sebring, Winona