Omaha Online Order Form

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 **$25 distance fee added for cities outside of Omaha**

please select the dumpster size you need

Type of Material

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

please specify pick up instructions

Dumpster Placement Instructions

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*

ONLINE ORDER - DUMPSTERMAXX - OMAHA