Company:
Company Address:
City:
State:
ZipCode:
Phone Number:
Company Fax:
Contact Person:
Type Of Business:
Email:
How often is your trash collected?
once a week twice a week 3 times a week 4 times a week 5 times a week 6 times a week once a month every other week on call
What type of trash is collected?
construction debris other food waste paper waste
Do you recycle?
What do you recycle?
paper metal cardboard tin plastic other
What size roll-off container do you currently use?
2 yd. 4 yd. 6 yd. 8 yd. 10 yd. other 20 yd. open top 20 yd. compactor 30 yd. open top 30 yd. compactor 40 yd. open top 40 yd. compactor not sure
Do you currently have a service agreement with another waste hauler?
If so, what is the expiration date of the service agreement?
Expiration Date:
What is your approximate monthly charge?
$0 - $100 $200 - $300 $300 - $500 $500 - $900 Over $900
How would you rate your current waste hauling service?
Excellent Good Okay Fair Poor Other
What do you like about your current service?
on time recycling containers billing drivers other
Dislike?
Any comments?