To sign-up for our professional trash can cleaning service, please complete the following agreement form in its entirety.
CanGienic Pricing
Cans
Pay annually
Pay quarterly
Savings for
paying anually
Per Can
Total
Per Can
Charge
Total
1
$ 7.00
$ 84.00
$ 8.50
$ 25.50
$ 102.00
$ 18.00
18%
2
$ 6.00
$ 144.00
$ 7.50
$ 45.00
$ 180.00
$ 36.00
20%
3
$ 5.67
$ 204.00
$ 7.17
$ 64.50
$ 258.00
$ 54.00
21%
First Can
$ 7.00
$ 8.50
Additional Cans
$ 5.00
$ 6.50
•
Customer Information
First Name
:
Last Name
:
Address
:
City
:
State
:
Zip
:
E-mail
:
Best Phone Number
:
•
Service Information
Your Home’s Trash Collection Day
:
Select Day
Monday
Tuesday
Wednesday
Thursday
Friday
not sure
Your Community Type
:
Select One
Not Gated
Gated w/Guard
Gated w/Code
If Gated w/Code, please enter gate code
:
•
Payment Plans –
SELECT ONE OPTION
A minimum term length of 1 year is required for ALL of our services.
Please select one of the following payment options.
Option 1 –
Pay Annually
Select Annual Payment Option
Trash Can Only = 1 Payment of $84.00
Trash Can + Recycle Can = 1 Payment of $144.00
Trash Can + Green Can = 1 Payment of $144.00
Trash Can + Recycle Can + Green Can = 1 Payment of $204.00
I prefer to pay Quarterly in OPTION 2.
Option 2 –
Pay Quarterly
Select Quarterly Payment Option
Trash Can Only = 4 Payments of $25.50
Trash Can + Recycle Can = 4 Payments of $45.00
Trash Can + Green Can = 4 Payments of $45.00
Trash Can + Recycle Can + Green Can = 4 Payments of $64.50
I have chosen OPTION 1 to pay Annually
•
Credit/Debit Card Information
Card Type
:
Select One
American Express
Discover
Mastercard
Visa
Name on Card
:
Card Number
:
Expiration
:
Select
1
2
3
4
5
6
7
8
9
10
11
12
Month,
Year
Billing Address
:
(if different than above)
City
:
State
:
Zip
:
*Credit or Debit Card will be charged prior to commencement of service. If you chose the quarterly payment plan, Credit or Debit Card will be charged prior to commencement of service and quarterly thereafter.
Click this box to confirm that you understand and agree to our
Service Terms and Conditions
, which includes the obligation to stay in the program for one full year.
Please tell us how you heard about us
:
Select One
Sales Person
Driver
Flyer
Newspaper Insert
Valpak Ad
Neighbor
Web Search
Other
If other
:
Business Opportunity
Privacy Policy
l
Eight Horses
