Select preferred delivery date:*

Is billing address same as service address?
YesNo

Material to be disposed of:*

Bin placement instructions:*

Would you like to add an authorized person to this order?
YesNo

I declare under penalty of perjury that I have examined all the information on this form, and it is true and correct to the best of my knowledge. I also understand that the rental of the container is for a 7 day period. If you would like to make arrangements to keep your container for more than 7 days, please contact Valley Vista Services Customer Service Representative. A demurrage charge per day will apply for any period over 7 days.

Liability Waiver

The undersigned customer of Valley Vista Services, Inc. hereby, releases the company from all liability or obligation to pay for damages or injury which may occur by reason of the customer requesting that a waste disposal bin or container be placed in the private property of said customer by the company.

Other Terms and Conditions

• All material must be within the container and cannot exceed the level line as indicated on the container.

• Additional charge will be applied to loads weighing more than the agreed tonnage.

• VVS cannot legally transport any loads weighing in excess of 10 tons.

• VVS will not accept: liquid, hazardous, explosive, toxic, tires, electronic wastes or radioactive wastes as directed by local, County, State and Federal regulations.

Customer agrees to provide clear access to the container for the purpose of loading and unloading. In the case that VVS cannot perform service for the aforementioned reasons, or if the driver is required to wait in excess of 10 minutes, a stand-by charge will be assessed.

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