Iliamna Landfill Business Application-Check Payment

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Iliamna Landfill Business Application-Check Payment

Application for Business Charges

Instructions

This packet consists of: Instructions, Fee Schedule, Application. You need one application for each business you are applying for. There are three steps to completing your Application Packet:

1. Fill out the Application for Business Charges

Reminders: Please complete the entire document. Incomplete applications will not be accepted.

2. Enter the full billing address including the city, state, and zip code.

3. Return the Completed Forms to the Iliamna Landfill Director Sue Anelon. The application process requires this Application.

Additional Information:

1. Once your forms are received your account should be activated within no later than one week.

2. A card will be mailed to the USPS address provided on the application or can be picked up at Iliamna Village Business Administration Building.

3. Your drivers are required to have this card with them each time they come to Iliamna Landfill.

Types of payment accepted: Pay your invoices by either mailing a check or dropping off at Iliamna Village Council Building. Make Checks Payable to Iliamna Village Council if paying by Credit or Debit there is a 3.25% processing fee applied on invoice.

Mail: Iliamna Landfill PO Box 286, Iliamna AK, 99606.

Physical Location: Iliamna Village Council Building

For more information please see out website at www.iliamnavc.org/iliamnalandfill

Email *

Cannot pre-fill email

Business Name *

Your answer

Business Account Type *

I am applying for the following business account type

Seasonal Local Business $4,000.00

Year Around Local Business $2,500

Other:

Business Billing Address *

Your answer

Business City *

Your answer

Business Zip *

Your answer

Business Phone *

Your answer

Contact Name (First, Last) *

Your answer

Contact Email: *

Your answer

Type of Business *

Sole Proprietorship

Partnership

Corporation

LLC

Other:

Required

Federal ID or SSN *

Your answer

Business Owners/Partners/Officers *

Name, Residence Address, Position

Your answer

Business Owners/Partners/Officers *

Name, Residence Address, Position

Your answer

Business Owners/Partners/Officers *

Name, Residence Address, Position

Your answer

Applicant Certification

By checking this box I agree to the following *

APPLICANT CERTIFICATION: The undersigned certifies that s/he is the owner/partner/officer of this business, has lawful authority to sign this application, and agrees to pay the applicable rates and abide by the terms and conditions as prescribed by the Iliamna Landfill. Acceptance of this application by the Iliamna Landfill constitutes a contract between the ILIAMNA LANDFILL and the applicant. All cost incurred by Iliamna Landfill for collection of any unpaid accounts shall be paid by the applicant.

Required

By checking this box I agree to the following *

The ILIAMNA LANDFILL reserves the right to require a deposit on account or to request payment at the time of disposal. All fees shall be the obligation of the disposing party. Disposers shall be issued an invoice at the time of disposal with payment due within thirty (30) days of the disposal date. If the account falls into arrears, further use of the Iliamna Landfill charge account may be denied or suspended until the amounts due, including collection expenses and late fees, are paid in full. Continuously delinquent accounts may result in the revocation of charging privileges.

Required

By checking this box I agree to the following *

Charges cannot be made at the Iliamna Landfill unless a valid Iliamna Landfill charge card is presented to the attendant at the time of disposal. The Iliamna Landfill has the right to deny the use of charge cards at its facilities if payment is delinquent.

Required

By checking this box I agree to the following *

I hereby declare that the information provided is true, accurate, and complete to the best of my knowledge and belief and is voluntarily submitted for the purpose of receiving ILIAMNA LANDFILL waste services. It is understood that upon presentation, this application becomes ILIAMNA LANDFILL property. I also certify that I am eighteen (18) years of age of older.

Required

By checking this box I agree to the following *

I understand that my charge account should be protected from unauthorized users and that I will be held responsible for any charges occurring on my account unless I have notified the ILIAMNA LANDFILL “Iliamna Landfill” to cancel the cards.Charge cards issued to my company may not be loaned or used by any other disposer unless the ILIAMNA LANDFILL “Iliamna Landfill” authorizes the use prior to any loads being brought into the ILIAMNA LANDFILL facility.

Required

Iliamna Landfill Access Cards will be mailed to the USPS billing address provided above or may be picked up at IVC Admin Building. Number of cards requested (up to 2).

Number of Landfill Access Cards Requested (up to 2) *

One Landfill Access Card

Two Landfill Access Cards

Required

Landfill Access Card Name(s)

Your answer

Preferred contact method *

Phone

Email

Required

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