Please correct the field(s) marked in red below:

Refuse-ONLY, Commercial - Inside City

Application for Refuse Services ONLY

SERVICE LOCATION INFORMATION

Service Address - Street, Apt/Ste
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Service Address - City, State, Zip Code
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Requested Service Start Date (no weekends or holidays):
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Requested Refuse Cart Size (one cart per dwelling unit):
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Requested Dumpster Service (subject to approval by the Public Works Department):
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Dumpster Pickup Frequency
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Dumpster Placement (Street placement is not allowed unless approved by the Public Works Department):
What type of material will be in the Dumpster?
I hereby agree to indemnify, defend and hold the City of Santa Cruz, its agents and employees harmless from any claims for damage, death or personal injury which may result from the Dumpster's use, movement or placement during the course of its rental through this account with the City of Santa Cruz. This agreement does not extend to liability arising from the negligence or intentional misconduct of city staff, as determined by court judgement.
I have read, understand, and agree with the above declaration.
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APPLICANT INFORMATION

Business Name:
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Owner/Corporate Officer Name:
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Billing Address - Street, Apt/Ste
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Billing Address - City, State, Zip Code
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Primary Phone:
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Alternate Phone:
E-mail:
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Business Type:
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Business ID - Document type
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ID - Document Number
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ID - Issued by (State or Country)

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City Business License Number:
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Previous Service Address with SCMU
I DECLARE UNDER PENALTY OF PERJURY THAT 1) I AM THE RESPONSIBLE PARTY AT THE SERVICE ADDRESS AND/OR AN AUTHORIZED REPRESENTATIVE OF THE BUSINESS, AND 2) THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT. I ACCEPT RESPONSIBILITY FOR THIS UTILITY SERVICE AND AGREE TO ABIDE BY ALL RULES AND REGULATIONS ESTABLISHED BY THE CITY COUNCIL GOVERNING UTILITIES.
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