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Services
Sanitary Portable Restrooms
Special Event Portable Restrooms
Sanitary Restrooms
Sanitary Hand Cleansing Stations
Shower Trailer
Sanitary Restroom Trailers
Roll Off Dumpsters
Grease Trap Cleaning
Choosing The Right Portable Bathroom
Solar Surveillance Towers (Sst)
Kitchen Exhaust & Hood Cleaning
About
Service Area
Join Our Team
Services
Sanitary Portable Restrooms
Special Event Portable Restrooms
Sanitary Restrooms
Sanitary Hand Cleansing Stations
Shower Trailer
Sanitary Restroom Trailers
Roll Off Dumpsters
Grease Trap Cleaning
Choosing The Right Portable Bathroom
Solar Surveillance Towers (Sst)
Kitchen Exhaust & Hood Cleaning
About
Service Area
Join Our Team
request service
Customer Application
Step
1
of
6
- Company Tax Info
0%
Phone
This field is for validation purposes and should be left unchanged.
Billing Name
(Required)
DBA
(Required)
Phone
(Required)
Federal Tax ID
(Required)
Tax Exempt
(Required)
Yes
No
Please provide copy of exempt certificate with completed application.
Mailing Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Iowa
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Maryland
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North Carolina
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Northern Mariana Islands
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Asset Location Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Site Contact Name
(Required)
First
Last
Phone
(Required)
Type of Business
(Required)
Date Established
(Required)
MM slash DD slash YYYY
AP Contact Name
(Required)
First
Last
AP Contact Email
(Required)
Enter Email
Confirm Email
Preferred Billing Method
(Required)
Mail
Email
AP Email for invoice submission
(WSI prefers to send all invoices via email. Please be sure when listing a billing email, that a general email may be beneficial in ensuring timely payment. Example: AR@WasteSolutionsofIowa.com)
Purchase Order Number Required
(Required)
Yes
No
Certificate of Insurance Needed
(Required)
Yes
No
(Please note, WSI may require a current COI for but not limited to, Job Trailers, SST Equipment, etc.)
Has your company ever been bankrupt
(Required)
Yes
No
Please explain:
(Required)
Vendor References
Business Name
Point of Contact
Phone
Email
Actions
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Bank References
Bank Name
Bank Contact Name
Bank Phone
Email
Bank Address
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Entries.
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Application:
Completed application is not a guarantee that WSI will approve the requested rental of our equipment or services. Waste Solutions of Iowa reserves the right without prejudice, to approve or not approve customer applications. Applications will be sent out every 3 years to be updated and returned to Waste Solutions of Iowa, failure to provide updated information may result in temporary holds until updated information is received.
Termination:
Waste Solutions of Iowa may terminate service and/or pickup of any deployed assets at any time upon notice.
Liability:
Waste Solutions of Iowa shall be liable
ONLY
for damages that are a direct result of our own negligence.
Payment:
Construction and/or Reoccurring Rental/Service Customers. Credit card and autopay is required for non-account holders and/or for those beyond 45 days past due. Notice to owner will be processed within the first 30 days of delivery. Nonpayment will result in a “Stop Service” status and could result in a lien placement of said property. The billing cycle will be in advance every 28 days and interest on any past due balances over 30 days shall be at the rate of 3.5%. Late fees will NOT be removed from the account by payment of the billed amount.
Legal Action & Jurisdiction.
In the event Waste Solutions of Iowa needs to take legal action, jurisdiction shall be with Polk County. Legal action may include, but not limited to, filing mechanic liens, turning account over to collections company or civil action for a money judgment. Customer will be responsible for all costs and expenses including attorney fees.
Consent
(Required)
I confirm I have read and agree to the conditions listed in this application and what I have provided is correct to the best of my knowledge. Waste Solutions of Iowa is authorized to investigate the customer’s credit worthiness by contacting the listed references and/or Bank Reference portion of this application if desired.
Signature
(Required)
Signature
