2. Name or business name *
4. Delivery Address
6. Container placement location instructions*
8. Date to be Delivered*
   Date to be Delivered

   Select Date from Calendar (Weekdays ONLY)

9. Phone number *
10. Email address*
12. Billing Address*
14. Are you currently a City of Idaho Falls utility customer?*
15. If YES what is your account number?
17. Two Items of Identification
19. Driver's License or Government issued ID #*
20. Last 4 digits of your social security number (or business tax ID)*
22. Copy of ID(s):*
    Driver's License or Government issued ID #
24. What type of garbage container are you needing?*
    -- Select One --95 Gallon3 Yard Temp3 Yard Perm30 Yard
26. I hereby request a garbage container at the above location and agree to pay for all sanitation services used, delivered or made available at this location until I notify the City in writing to discontinue such services. I agree that the sanitation container will be delivered subject to the terms and provisions of the Idaho Falls City Code as it now exists or may be generally amended from time to time. I understand the City makes no warranties of any kind and all warranties, whether expressed or implied including all warranties of merchantability and fitness for a particular purpose, are expressly disclaimed. I represent that I am either the owner of the premises described above or am leasing or renting the property from the owner. I also represent that neither I nor any member of my household have a delinquent utility account with the City. I understand that any past debt owed to the City must be paid in full before any sanitation containers can be delivered.
28. Customer Agreement*

    1. I Agree

    By selecting the "I Agree" button, you are signing this Agreement electronically. You agree that your electronic signature is the legal equivalent of your handwritten signature and you consent to be legally bound by this Agreement's terms and conditions.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field