Curbin

Name

First

Last

Email

Phone

Service Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

When is your trash and/or recycling collection day? Select all that apply.

Are your bins stored where access details will be needed? (i.e. behind a locked gate, in the garage, in a shed, etc.)

Yes
No

If yes, please provide those access details here.

In order to ensure the safety of our team members, all pets must be secured on the day prior to and the day of collection. Are there pets on the property?

Yes
No

In order to avoid triggering any alarms, we require knowledge of any security systems that would need to be disarmed, prior to our team accessing your property. Do you have any such alarm or security systems in place (including in the garage, the exterior of the home, any sheds, or wherever your bins are stored)?

Yes
No

If yes, please provide details on how to disarm the alarm or avoid triggering this alarm.

Base Price For Monthly Subscription

Price: $49.00

Add-Ons

More Than 2 Bins: 3 Bins Total – $10.00
More than 2 Bins: 4 Bins Total – $20.00
More than 2 Bins: 5 Bins Total – $30.00
Garbage & Recyling Collection on Separate Days (Select this option if you checked two collection days above) – $5.00

Total Amount

$0.00

Payment Method

Card Number

Expiration Date

Security Code

Card Holder Name

I understand that I am signing up for a monthly subscription service where the card provided will be charged monthly. I also understand that I am free to cancel this service and stop payments at any time by reaching out to Curbin at contact@curbin.co.

Yes, I understand.

Given the variability in how each municipality handles collection day when it falls on a holiday, please expect return service to be performed within 24-48 hours of those specific days. Curbside delivery will be performed as ususal on the day prior to collection.

I have read and agree to the Terms and Conditions.*

Checkboxes

Yes I have, and I agree to the Terms and Conditions.

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