Back Door Sanitation Service Application

Application Date*
Date Format: MM slash DD slash YYYY
Date Service to Begin*
Date Format: MM slash DD slash YYYY
Preferred Length of Service*
Applicant Name*
First Last
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Same as Mailing Address?*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Residency*
Emergency Contact Information
Name of Contact*
First Last
Relationship*
Contact Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Contact Email*
Rental Agent Information
Agent Name*
First Last
Agent Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Agent Phone*
Agent Email*
Applicable Fees:
Annual Service: $175.00
Seasonal Service: $95.00
ETJ Service: $300.00 Annually
By submitting this application form, I agree that the Town of Montreat has my permission to collect and dispose of residential solid waste from my premises. I further agree that the garbage containers shall be freely accessible and not be placed inside closed buildings or a gated area and that the Town is not responsible for any damage to private property resulting from providing this service.
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Emergency Contact Information