Polycart Order Form Complete this form to sign up for weekly polycart trash service. PLEASE HAVE TRASH OUT BY 6:00 AM. WE RUN ALL HOLIDAYS EXCEPT CHRISTMAS DAY.Note: items not allowed in our polycarts include rocks, bricks, concrete, manure, batteries, tires, oil or paintChoose how many polycarts you need:(Required) 1 Polycart ($35 per month) 2 Polycarts ($45 per month) Sales Tax Price: $0.00 5% Fuel Surcharge Price: $0.00 Total Monthly Service Enter Start Date(Required) MM slash DD slash YYYY Enter additional information or request a call back here:Sign up for automatic monthly billing? Yes Customer AgreementAgreement Date: December 4, 2025Read and indicate your agreement by selecting the "I agree" box below.(Required)- Please have trash containers out by 6:00am - Please bag all loose trash and keep the container clean and free of pests! - Note: items not allowed include rocks, bricks, concrete, manure, batteries, tires, oil or paint cans - We run all Holidays except Christmas Day I agreeEnter Your Information BelowNew Customer? New Customer Account Number(Required)Enter your 4- or 5-digit account number, located at the top right corner of statement, below the due dateName(Required) First Last Company NamePhone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Different Service Address Yes Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code FollowFollow 2019 Alford Services, Inc.
