BURNS WASTE NEW CLIENT FORM Thank you for choosing Burns Waste as your Waste Management provider!To ensure a smooth registration, please complete all required information in the provided fields. We’re looking forward to working with you! Name * First Name Last Name Contractor (if applicable) Phone * (###) ### #### Billing Email * All invoices will be sent to the provided email address Billing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country ALL new clients must provide a credit card to put on file. These are stored securely and are only used for emergencies. You will ALWAYS be notified if your stored card is going to be used. We only provide services to accounts with verified cards on file. You will be notified if your CC is not validated upon creating your account. Credit Card Number * Credit Card Expiration Date * Credit Card Security Code * Credit Card Zip Code * Service Address (address that your dumpster will be dropped) * Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred Drop Off Date Date * MM DD YYYY Thank you!
