Roll Off Request

CITY OF ZEPHYRHILLS

PUBLIC WORKS DEPARTMENT, SANITATION DIVISION

39421 South Avenue Zephyrhills, FL 33542 Telephone: 813.780.0022


ROLL-OFF REQUEST FORM

 

TODAYS DATE: __________________________            REQUESTED DELIVERY DATE:  _________________________                           

CONTAINER SIZE REQUESTED: _________________  20 YARD  ___________            30 YARD ___________                

LOCATION (ADDRESS) OF CONTAINER: _________________________________________________________________ 

CONTACT NAME (ON-SITE): ______________________________    PHONE CONTACT (ON-SITE): __________________       

BILLING INFORMATION:

COMPANY OR RESIDENT NAME: _______________________________________________________________________

ADDRESS: ___________________________________ CITY: ________________________ STATE: _____  ZIP: _________

REQUESTED BY: (SIGNATURE): ______________________________ PRINTED NAME: ___________________________       

DRIVER'S LICENSE NO.: ___________________________________  ACCOUNT NO. (If city resident): __________________

ROLL-OFF PRICING

 

DELIVERY CHARGE: (Non-Refundable) $45.00

DEPOSIT: 20 YARD (Refundable): $250                                          30 YARD (Refundable): $300

MONTHLY RATE: 20 YARD (30 DAYS OR LESS):$ 170.00

MONTHLY RATE: 30 YARD (30 DAYS OR LESS): $180.00

DISPOSAL FEE: 20 YARD (includes one pull): $200.00                  30 YARD (includes one pull): $300.00

ADDITIONAL PULL CHARGE: $100 per pull.

Household garbage, tires,Industrial refuse or hazardous waste are prohibited from being placed in the container (additional charges may apply if prohibited items are placed in container). The City of Zephyrhills reserves the right to inspect the roll-off before removal. The City of Zephyrhllls will not be responsible for property damages.


FOR OFFICE USE ONLY:                                                                   CONTAINER NUMBER: ____________________________                                         

DATE DELIVERED ON SITE: _________________________          EMPLOYEE SIGNATURE: __________________________ 

DATE PICKED UP: _________________________                           EMPLOYEE SIGNATURE: __________________________