Full Circle Recycling (FCR) Application Form
Contact Information: blandingfullcirclerecycle@gmail.com - Phone 435-485-1010
Webpage: www.sanjuanfoundationutah.org - Click Full Circle Recycling Tab
Email address *
Application Date *
MM
/
DD
/
YYYY
Name *
Your answer
Pick Up Address (Include City): *
Your answer
Mailing Address (Include City, State and Zip):
Your answer
Phone Number *
Your answer
Email Address (Please note that email address is required. All invoices will be sent electronically to this email address, and will include a "Pay Now" button that will allow you to pay via credit card or bank account.) *
Your answer
What Day does your trash get picked up? *
Any additional information needed for your trash pick up?
Your answer
Who referred you?
How did you hear about us?
Your answer
I understand that this is an application for becoming a customer in the recycling project. I agree to and understand the following: 1.) Services for recycling will start in the week that I sign up and I will be billed at a prorated amount during the week my pick up begins. 2.) Pay $18/mo for residential curbside pick ups. 3.) Pay $18/mo for business curbside/outside pick up or $25/mo for business onsite/inside pick up per bin (1 bin = $18/mo or 2 bins = $36/mo, etc.) 4.) Pay one-time fee of $25, for each 32-gallon recycling bin I purchase from Full Circle Recycling. 5.) My recycling bin will be emptied the same day as my regular trash pick up. 6.) I must have my recycling container placed next to my trash container the evening before or the morning of my trash pick up for it to be emptied. 7.) If I want to discontinue service or have any changes to service, I must notify FCR immediately. 8.) If I do not pay for recycling services and am 31 days or more past due, my services will be discontinued until payment is made in full. 9.) If I become past due and FCR or its multi-agency collaborators must collect funds, I will be responsible for any collection or attorney's fees, as well as my past due balance. *
NAME (Signature) - My Name typed below, constitutes my signature and agreement, and by submitting this application I agree to the above terms and conditions. *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of San Juan Foundation. Report Abuse