Service Request Form We will be in touch to set up a secure payment Name * [select* Service include_blank "1 Bin - Monthly Cleaning/ Billed Quarterly $45" "2 Bins - Monthly Cleaning/ Billed Quarterly $90" "3 Bins - Monthly Cleaning/ Billed Quarterly $135" " 1 Bin - Monthly Cleaning/ Billed Annual $150" "2 Bins - Monthly Cleaning/ Billed Annual $300" "3 Bins - Monthly Cleaning/ Billed Annual $450" "One-time Cleaning - $60] Preferred Payment Method: * —Please choose an option—CashCheckCard Name * Email * Phone Number * Address * Zip Code * Trash Pick Up Days Promo Code How did you hear about our service? —Please choose an option—Bin HangerFriendGooglePostcardSocial MediaTruckOther Is there anything else you feel we should know? * Required By clicking "Send" you are agreeing to our Terms & Conditions. Δ
