AR Application Roll-off and Trash Services

Account Number*

Bill To:

Name*

Email Address:*

Address*

City, State, Zip code*

Deliver/Pick-up address:

Address*

City, State, Zip code*

Scheduled Pick-up

Date

Container Type*

New or existing customer?*

Additional Container?*

Final Pickup?*

Number of pickups per week?*

Are you inside or outside city limits?*

Contact Name:*

Phone Number:*

Notes for driver:

Date of service change*

TERMS AND CONDITIONS OF SERVICE AGREEMENTS

WASTE MATERIALS: Customer warrants that that materials delivered to the CITY OF UVALDE will not contain any hazardous toxic or radioactive wastes. RESPONSIBILITY FOR EQUIPMENT: The equipment furnished by the CITY OF UVALDE hereunder shall remain the property of the CITY OF UVALDE, and Customer shall have no interest in such equipment. Customer shall be responsible for all loss or damage to the equipment except for normal wear and tear or for loss or damage resulting from the CITY OF UVALDE’s handling of the equipment. Customer shall not overload (by weight or volume), move or alter the equipment, and shall use the equipment only for its property and intended purpose. Customer agrees to indemnify, defend and hold harmless the CITY OF UVALDE against all claims, damages, suits, penalties, fines and liabilities for injury or death to persons or loss or damage to property arising out of Customer’s use, operation or possession of the equipment. On collection day, Customer shall provide unobstructed access to the equipment. If the equipment is inaccessible, Customer will be notified, and any additional collection service or attempt to provide such service shall be charged as an “extra pick-up”. CHARGES AND PAYMENTS: Payment shall be made by Customer within 10 days of billing; in the event that payment is not made when due, the CITY OF UVALDE may terminate the agreement on notice to Customer. The CITY OF UVALDE may recover any equipment on the premises of Customer and recover the liquidation damages. Please provide email if you would like for the City to email your bills. If you would like, please provide a phone number if you want a courtesy call when your bills are due.

Date*

Accepted by:*

Driver's License / Identification card upload