ONLINE ORDER - DUMPSTERMAXX - PHOENIX Contact Name please enter first and last name Phone Number please provide a valid contact number where you can be reached Delivery Address please enter the address where the dumpster should be delivered Dumpster Size 10 YARD DUMPSTER $295.00 - includes 1 ton of weight, $65.00 each additional ton, 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge 15 YARD DUMPSTER $319.00 - includes 1 ton of weight, $65.00 each additional ton, 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge 20 YARD DUMPSTER $359.00 - includes 2 tons of weight, $65.00 each additional ton, 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge 30 YARD DUMPSTER $399.00 - includes 3 tons of weight, $65.00 each additional ton, 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge 40 YARD DUMPSTER $459.00 - includes 3 tons of weight, $65.00 each additional ton, 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge INERT LOAD - CONCRETE, BRICK, OR DIRT DUMPSTER $399.00 - FLAT RATE - 10 TON MAX LIMIT (no other materials allowed or $65.00 each ton inside if mixed with trash) - 14 day rental included, $20.00 for each additional day, plus 20% fuel surcharge please select the dumpster size you need Type of Material CONSTRUCTION / REMODEL HOUSEHOLD / BUSINESS CLEAN OUT YARD WASTE INERT LOAD - CONCRETE / BRICK / DIRT (NO OTHER MATERIALS) please indicate type of waste Delivery Date please specify exact day and date of delivery the dumpster is needed. (Ex. Monday 01/01/18) Pick Up Date WILL CALL - customer is responsible for contacting us and scheduling pick up date (1 business day notice is required for next day pick ups) AUTOMATIC PICK UP - we will automatically pick up your dumpster on the 14th day please specify pick up instructions Dumpster Placement Instructions DRIVEWAY - SINGLE CAR DRIVEWAY DRIVEWAY - DOUBLE CAR DRIVEWAY - LEFT SIDE DRIVEWAY - DOUBLE CAR DRIVEWAY - RIGHT SIDE DRIVEWAY - DOUBLE CAR DRIVEWAY - MIDDLE STREET - IN FRONT OF PROPERTY ON STREET **Please note, for street parking some cities may require you to obtain a permit** *OTHER - Please describe other instructions in field below Tell us where you want us to place the dumpster. **When describing dumpster placement, please refer to point of view as if you were standing on the street looking at the property. For Ex "park on left side of driveway" *OTHER - Parking instructions Please describe other specific parking instructions Credit or Debit Card Number Please enter full credit or debit card number only. All major credit or debit cards are accepted. Expiration Date Please provide month and year of credit card expire date. For Ex "10/19" or "October 2019" Name on credit or debit card Enter name as it displays on your credit or debit card Credit or debit card billing address Please provide credit or debit card complete billing address. For Ex "1111 Maple Ave Beverly Hills, CA 52130" Email address Please provide a valid email address so that we can send you a confirmation of your order and receipt Signature - You hereby authorize Dumpstermaxx to charge your credit or debit card for the amount listed above for our dumpster services, have read and agreed to our terms and conditions listed below Please type in your full name to provide your authorization and consent of our *TERMS AND CONDITIONS* Submit my order
