Print

  
 
 
 
First Name::
  Last Name::
 
 
 
Address::
 
 
 
City::
State   California       Zip
 
 
 
Daytime telephone::
  Evening time telephone::
 
 
Cell Phone #
Email::
 
 
 
What day is your Trash Can emptied?   Monday
Tuesday
Wednesday
 
 
      Thursday
Friday
 
 
 
What Time is your Trash Can emptied? Early morning
Mid morning  
Lunch
Afternoon
 
 
      Early evening
Not sure
 
 
 

Where would you like your Trash cans returned to?

   
 
 
Which Payment Plan would you like?
Annually
6Months
3Months
Monthly
 
 
What service would you like?
Twice A Month
Once A Month         
Once Off
 
 
How many Trash cans require cleaning?  
Trash
Recycle
Green
Other
 
 
Home Owners Association
 Discount Code#
Pensioner’s
Discount Code#
 
 
 
Total Cost $
     
 
 
 Payment Method
Debit or Credit Card
Check
 
 
 
Credit card #
Valid-Thru
Card Type
 
 

Two Cross Streets & Additional Information & Comments (e.g. Gated Community Access)

       
 
 
 
 
 
 

Please mail Service Aggreement to
 Shiny Can,  26741 Portola Pkwy., Suite 1E#904,  Foothill Ranch CA 92610. Telephone (949)215-1191