Roll-Off Service Request
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Your Name *
Your Phone *
Your Email
What is your service address? *
Where would you like us to drop the roll-off container? Please list full address.
What is your mailing address? *
If your street address and billing address are the same, you can just write "Same"
Start Date *
When would you like us to drop it off?
MM
/
DD
/
YYYY
Finish Date *
When will you be finished with it?
MM
/
DD
/
YYYY
How did you hear about us?
Roll-Off Service Waiver *
Customer acknowledges that it has the care, custody and control of the equipment owned by Ava’s Waste Removal and accepts responsibility for the equipment and its contents while it is on customer’s property. Therefore, customer agrees to indemnify and hold Ava’s Waste Removal from and against any and all claims for loss of or damage to property, injury or death of person or persons resulting from or arising in any manner of customers use, operation or possession of any equipment furnished under this agreement.Customer acknowledges that Ava’s Waste Removal employees may drive company vehicles on customer’s property and accepts responsibility for any and all damage that may occur from Ava’s Waste Removal. This includes damage to(e.g. roads, culverts, fences, mailboxes, guttering, basketball goals, landscaping, driveways, curbs, lawn, sprinkler systems, shrubbery, etc.) or other areas that the truck may contact while attempting to service customer’s containers.Furthermore, the customer will warrant that all waste placed in the container is of a non-‐hazardous nature, and no liquids will be placed in the container. Also, tires, computers, (desktop, laptop, notebook etc.), monitors, peripheral devices, printers, fax machines, televisions, DVD/VHS players, video game consoles, radios and stereo equipment are not acceptable in the roll-off dumpster.
Required
Questions or Comments?
Please add any additional information that we may need to accommodate your requests.
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