Sign Up for Recycling Services Billing InformationCompany Name*Contact Person*Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email Address* Customer Service InformationCustomer Name*Service Address is the Same as Billing Address* Yes No Service Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Rates for Single Container, Weekly Service*Please choose your requested bin size:64-gallon -- $85/month96-gallon -- $105/month1 yard -- $195/7month1.5 yard -- $215/month2 yard -- $230/monthIf you require multiple days of service or require multiple bins, please describe below. A customer service representative will call you to discuss.Invoice and Payment Options*E-mail Invoice and Online Payment: Civicorps will e-mail you an invoice and you can pay online with a major credit card or Pay Pal.Paper Invoice and Mailed Check: Civicorps will mail you an invoice and you can mail us a hardcopy check.Please choose from the following options:Agreement* I agree By checking this box, I hereby agree to remit the Monthly Service Charge to Civicorps within 15 days of invoice. A 3% late fee may be added to balances that are 30 days past due. Signature (please print your name and title)*