New Client Form

New Client Form

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Customer Billing Information

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Are PO # Required*
Do you wish to pay by Credit Card for a fee of 2.75%

Generator Information

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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.