New Client Form New Client Form Optional: Download Printable PDF "*" indicates required fields Customer Billing InformationBill To Company Legal Name*Bill To Company DBA (if applicable)Tax ID (attach copy)*Tax File Upload (PDF only)*Accepted file types: pdf, Max. file size: 256 MB. Entity Type (check one)* Individual/Sole Proprietor Corporation LLC Billing Address*Contact Name*Billing Phone*Billing Email* Reseller Permit* Yes No Reseller Permit Upload (PDF only)*Accepted file types: pdf, Max. file size: 256 MB. Are PO # Required* Yes No Do you wish to pay by Credit Card for a fee of 2.75% Yes No Generator InformationGenerator Name*Physical Site Address*EPA ID #*Mailing Address (if different)NAICS*State ID #*Generator Size* VSQG SQG LQG MQG Site Contact Name*Phone*Email* Emergency Contact NameEmergency PhoneNotes & Special InstructionsPrint Name*Title*Date* MM slash DD slash YYYY Terms – WasteXpress payment terms are Net 30 days, unless otherwise specified in a signed contract. Interest of 1.5% per month, or themaximum allowed by law, will apply to all past-due balances. Credit card payments incur a 2.75% service fee. By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge, you have the authority to acceptthese terms, and you agree to the Terms and Conditions found here: www.wastex.com/terms-and-conditions.