Scale Account Application - https://tri-statedisposal.com
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Scale Account Application

Written by Tri State Disposal. Posted in Uncategorized

Scale Account Authorization Form

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General Information

Billing Address
Type(Required)
Receive Text Alerts(Required)
Mobile Users: Get updates on hours, closures, promotions.

Account Set Up

Types Of Materials You Will Be Disposing Of(Required)
Select all that apply to what you will bring in to dump.
Email Payment Receipt?
A receipt showing proof of payment will be emailed immediately after each dump.
Invoices & Statement Delivery
Select how you would like to receive billing information.

Vehicles & Authorized Users

Please provide a list of vehicle and/ or Authorized Users who are approved to dump under this account. You are responsible for notifying Tri-State Disposal of any changes to these authorizations.
Vehicles
License Plate
Vehicle Make, Model, Color
 
Authorized Users
Full Name
Relationship
 

Authorization & Payment

Payment Information(Required)
Select your form of payment.
Credit Card Details(Required)
How would you like to submit your credit card information?
Consent(Required)
By entering your name, you authorize Tri-State Disposal to process payments on the credit card provided for all dumps brought into this facility.
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