Senior Discount Application

Prior to completing, signing, and providing required documents, please read the Senior Discount Requirements for eligibility; applicants that do not fulfill the requirements may be ineligible. One discount per household/ address.

Date of Birth(Required)

Name(Required)

Last First Middle Initial

Service Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Type(Required)

Mobile

Landline

Along with this application, please provide a copy of the following. If the required documents are not received or do not fulfill requirements, your application may not be processed. There are no retroactive discounts.

A copy of the applicant’s valid driver license or state issued identification card with your current address.
A copy of your current trash providers (if not already with Tri-State Disposal) bill that indicated the applicant’s name as the account holder and address.

Required Documents Upload(Required)

Drop files here or

Max. file size: 50 MB, Max. files: 3.

1.) A copy of the applicant’s valid driver license or state issued identification card with your current address. 2.) A copy of your current trash providers (if not already with Tri-State Disposal) bill that indicated the applicant’s name as the account holder and address.

Date