NEW SERVICE APPLICATION

To apply for our services, kindly fill out the form provided below. It's important to note that we don't require any contract from you.

Company Name

First Name

Date of Birth required

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Tax ID

Last Name

Email Address

Phone

Alt Phone

Billing Address

Billing Address Line 2

City

Region/State/Province

Postal / Zip code

I prefer to rceive my bill by: Required

Mail

Email (Paperless Billing)

Service Address

Service Address Line 2

City

Region/State/Province

Postal / Zip code

Service Start Date required

Note

*I understand as the primary account holder I am responsible for all billing charges, including overfilling and special pickup items.

*I understand that containers are considered full when level with the top. There may be additional fees for containers whose lid will not close or items sitting outside of the container.

*I understand that dumpsters and roll-off containers have a minimum dumping requirement every 30 days.

*I understand that invoices are sent after the entire month has been serviced and payment is due every month. Past-due accounts may be subject to collections. Invoicing discrepancies must be brought to the attention of Golden Eagle Trash within 30 days of the invoice date.

Your Signature

Todays Date required

Thanks for submitting!

No Contract Required

EST. 1994

New Service Application

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