Special Offers
Are you new or existing customer?
New
Existing
Print out the
Terms and Agreements
and mail the form in.
Custom Disposal Inc.
P.O. Box 1428
Dallas, GA 30132
Name:
*
Street Address:
*
City:
Zip:
Subdivision / Neighborhood Name:
*
E-mail:
*
Home Phone:
Work Phone:
Cell Phone:
Would you like to recycle?
Yes
No
What date would you like to begin service?
...
Comments/questions:
Yes! Sign me up for 3 months free service!
By checking this box, I agree to the
Terms and Agreements
*
Alternatively, you can print out the terms and agreements page and mail the form in.
* Required Field
Custom Disposal Inc.
P.O. Box 1428
Dallas, GA 30132
Phone: 770.977.2788