DUMPSTER RENTAL FORM

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Full Name

Company Name (if applicable)

Email

Phone

Your Communication Preference

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Email

Desired Delivery Date

Address

Address Line 1

City

State

What do you intend to put in the Dumpster?

Please Provide Additional Helpful Details:

Do you accept?

I authorize C&C Services Group to charge my credit card as entered on this secure website for $470. This is calculated as 30 days rental x $4 = $120, plus the first load $275, plus the first ton $75. Your card will be charged every 30 days for the rental rate, and charged each time a load is taken to the appropriate landfill. Charges will be made to this card at a later time, including Additional Fees and Conditions if applicable, for tonnage fees, rental days added, disposal of non-standard items (ex. tires, mattresses, paint), or a transport fee if the site is beyond the 25 mile free delivery range. I have read and accept the terms of service as stated in the C&C Services Group Roll-Off Dumpster Rental Terms and Conditions.

Total

$0.00

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