Online Roll-Off Contract Form

Roll Off Order Form

Company / Name:(Required)

Email(Required)

Dumpster Address:(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

In Between Streets:(Required)

Contact Phone #:(Required)

Container Size:(Required)

Material:(Required)

Delivery Date & Time:(Required)

please allow 3 hour time frame

Pick Up Date & Time:(Required)

please allow 3 hour time frame

Alternate Side Parking (date & times):(Required)

Special Instructions:(Required)

Payment Information

Credit Card Type(Required)

CC Number:(Required)

Expiration:(Required)

Security Code:(Required)

Name on Card:(Required)

Billing Address:(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Credit Card Authorization

Date:(Required)

Size Dumpster(Required)

Select ONE Dumpster Rental Size below

10 Cubic Yard Dumpster for $495 with a 1 Ton weight limit; subject to weight overage charges

20 Cubic Yard Dumpster for $695 with a 2 Ton weight limit; subject to weight overage charges

30 Cubic Yard Dumpster for $795 with a 3 Ton weight limit; subject to weight overage charges

40 Cubic Yard Dumpster for $995 with a 4 Ton weight limit; subject to weight overage charges

10 Cubic Yard Dumpster for $1,100 for 100% pure load of Dirt, Brick, or Concrete

20 Cubic Yard Dumpster for $1,700 for 100% pure load of Dirt, Brick, or Concrete

I,(Required)

authorize Filco Carting Corp. to charge my credit card for renting a dumpster intended for waste removal. I have been given a set price for the dumpster with a weight tonnage limit. I will not load the dumpster higher than water level. I understand that if I go over the weight limit, I will be responsible for weight overage charges of $130.00 per ton over the limit. All boxes including roofing materials will be charged $150 per ton. Please note that there are additional charges on a per item basis for the following: $20 per car tire, $50 per truck tire, & $50 per refrigerator, $75 per mattress. If the dumpster does not go onto private property, I will be charged $75.00 +tax for a 5-Day NYC Street permit. I have been given a set price for a 15-day dumpster rental with a weight tonnage limit. After 15 days there will be a $25 per day fee. I am also responsible for securing at least 30 feet on the street, on the date of delivery/pick up to allow Filco Carting’s driver to properly and safely deliver/pick up the dumpster. If I do not properly secure a spot on the street, resulting in Filco Carting’s inability to deliver/pick up the dumpster, I will be responsible for a Trip Charge of $300.00 (in Brooklyn, Queens or Lower Manhattan) or $350.00 (in Staten Island, Bronx or Upper Manhattan) each time this occurs. All cancellations and/or modifications must be done Mon-Fri 8am-4pm.

Name of Card Holder:(Required)

Date:(Required)

Thank you for your business! How did you hear about us?(Required)

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