Exhibit 99.1
This Exhibit is a reasonable facsimile of the Service Agreement used by
CHOICE SANITATION. LLC
0000 Xxxxxxxx Xxx. Xx. Xxxxxx, XX 00000 (561) 461-8009 * (000) 000-0000
SERVICE AGREEMENT
NON- HAZARDOUS WASTE
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BILLING INFORMATION CUSTOMER NAME: SERVICE LOCATION INFORMATION
CUSTOMER NAME: CUSTOMER NAME:
STREET NUMBER: STREET NUMBER:
STREET NAME: STREET NAME:
CITY: CITY:
STATE: STATE:
ZIP: PHONE: ( ) ZIP: PHONE: ( ))
CONTACT: CONTACT:
FEDERAL ID#: FAX #:
SERVICE DESCRIPTION
I------I Roll Off Haul
I___I Front Load
SCHEDULE OF CHARGES
ROLL OFF:
FLAT RATE
HAUL RATE
LANDFILL TONNAGE RATE
RENTAL FEE
DELIVERY FEE
RELOCATE FEE
OVERLOAD PENALTY
FRANCHISE FEE
DEPOSIT
NOTICE TO OWNER FEE
$
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$
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$
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$ 100.00/month if roll
off not hauled
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$ 25.00
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$ 35.00
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$ 100.00
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$ 4% STL Co/5% Xxxxxx
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$
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$
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CONTAINER SPECIFICATIONS
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QUANTIDESCRIPTION SIZE OTHER
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Customer acknowledges that Contractor shall not be liable for any damages
to pavement, curbing, or driving surfaces resulting from its trucks or
equipment providing services hereby provided. Choice Sanitation, LLC
reserves the right to charge a fuel surcharge not to exceed 5%.
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FREQUENCY 0F SERVICE
[ ] ON CALL
[ ] PICK UP(S) PER WEEK FRONT LOAD:
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EFFECTIVE SERVICE DATE
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MON TUE WED THUR FRI SAT SUN SIZE S MONTHLY
SIZE S MONTHLY
SIZE S MONTHLY
SPECIAL INSTRUCTIONS:
INITIALS
1 Customer (homeowner) agrees to pay xxxx In full during each dump or agrees to
pay balance on credit card #.
Name: Expiration Date:
2. Any account that becomes 60 days past due will have its service stopped until
the account is paid.
3. Partial payments force a stop service immediately.
CUSTOMER: I agree to all terms and conditions on the front and back of this
contract
CHOICE SANITATION, LLC
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AUTHORIZED SIGNATURE SOCIAL SECURITY NUMBER
AND PERSONAL GUARANTEE
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TITLE DATE AUTHORIZED SIGNATURE
