[CONSTRUCTION & INDUSTRIAL] Junk Removal & Bin Rental Order Form

We've automated our bin rental bookings to save you (and us) time! Please complete the following order form to have your bin delivered. Please book your bin rental 24-48 hours in advance to ensure that your bin will be delivered on your requested date. We will call you upon receipt of your order to confirm the bin drop-off date. Thank you! [ENTER BUSINESS NAME, ADDRESS] Phone: (123) 456-6789 Email: YourName@YourEmail.com Website: YourWebsite.com

We offer clutter free junk removal services
Your Name * First Last
Home phone * - ### - ### ####
Cell phone (or best number to reach you) - ### - ### ####
Email Address
Scan Barcode

Confirm Email *
What size bin do you need? (4 day rental) *
6 cubic yard: $250 + taxes = $282.50 10 cubic yards: $310 + taxes = $350.30 15 cubic yards: $360 + taxes = $406.80
Bin rentals are used to discard construction materials (asphalt and concrete), home renovations debris (flooring, drywall, concrete, roofing shingles, demolition, landscape & gardening waste, garage clean ups, and household items.
What is the address where the bin should be dropped off? *
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
Major intersection? *
Scan Barcode
When would you like the bin DROPPED OFF? * / MM / DD YYYY
When would you like the bin PICKED UP? / MM / DD YYYY

Bin rentals are for 4 days. If you would like the bin to be picked up earlier, please specify the date
TERMS & CONDITIONS

Bin rental rates:

1. Drop off, pick up, and dumping charges included in all rates.

2. Bin rental rates are for 4 days from the time we drop off the bin. If you prefer a pick up earlier than the 4 days, then please specify in the "Pick up date" above.

3. Taxes included in rates.

RESTRICTIONS include:

- NO food waste
- NO flammable liquids or products
- NO hazardous waste
- NO liquid waste

Bins must NOT be filled past the bin wall height. If you exceed the maximum fill height, the bin will not be picked up and you will charged an additional fee for a second attempt for pick up.

If you have questions, call us.

All bins are subject to inspection at pick up.

Please read the above, then sign below. Once you submit this order form, you will be directed to the PayPal Checkout page to complete payment.
I have read the Terms & Conditions and Restrictions above, and agree:

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