EnviroWaste Registration Form

What works best for you today?

Enter your Zip Code

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Form Type

{serviceConfirmation}

Map

{serviceConfirmation}

Full Name

First NameLast Name

E-mail

example@example.com

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

Format: 000-000-0000.

Service Address

Location of trash pickup

City

State

Zip

Service?

Service Confirmation

Map

Phone 2 Type

Optional

Phone 2

OptionalFormat: 000-000-0000.

Preferred Bill Delivery

Service start date

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

Service Type

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

Billing Street Address

Billing City

Billing State

Billing Zip

How did you hear about us?

Select one.

Enter the referrer's phone number and name so we can apply their $20 credit.

Referred By

First NameLast Name

Referrer's Phone number

Format: 000-000-0000.

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:

2 yard dumpster$270.00

Pickup frequency

4 yard dumpster$340.00

Pickup frequency

Enter coupon

Subtotal Shipping Total $0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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

Preferred Ongoing Payment Method

Other

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

Start Service Initial Payment*

Start Service Initial Payment