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Residential Trash Service Request
Number of trash carts:
1 trash cart (95 gallon cart included with service for $22.00 per month/ $66 quarterly)
2 trash carts (additional 95 gallon cart is $5.00 per month/ $15 quarterly)
Quarterly Total: (1 x Week Trash Pick Up)
Quarterly Total: (1 x Week Trash Pick Up)
Name
First
Last
Service Address:
Street Address
Address Line 2
City
ZIP / Postal Code
Billing Address is Different
No
Yes
Billing Address:
Street Address
Address Line 2
City
ZIP / Postal Code
Phone Number:
Email:
Enter Email
Confirm Email
Desired Start Date
MM slash DD slash YYYY
(please allow 1 week to begin service)
Electronic Quarterly Billing
Yes, enroll me in electronic quarterly billing.
Statement of Service:
(Required)
I have read and agree to the
Terms and Conditions of Service
Notes:
Business Hours
Monday – Friday
8am – 5pm
Location
12914 Old Stage Rd.
Chester, VA 23836
804-234-4444