Application for Commercial Sanitation Service

Application for Commercial Sanitation Service
Date

MonthDayYear
Name of Business
Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you have a Current City of Dickson Business License?
Name of Business Owner
Business Owner Contact Number

Area CodePhone Number
Business Owner Email
How Would You Like to Receive Invoices?
Mailing Address for Invoices

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Number of Carts Requested (Maximum of Three Carts)
Number of Pick Up Days Requested
Do you need cardboard removal? (Cardboard must be empty, broken down, and placed next to cart.)
Select a Payment Option
City of Dickson Sanitation Policy-As of January 2021
I have read and understand the City of Dickson Sanitation Policy-As of January 2021
Signature of Owner
Date
Should be Empty: