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Garbage Service Agreement Form

  1. (if different from Service Address)
  2. Service Option (please check)*
  3. This information is used strictly to verify your identity with Daphne Utilities for billing and/or customer service purposes.

  4. Thank you for your business! Please leave your cart at the residence if you move/relocate. Failure to leave cart at residence location will result in a $70 replacement fee and will be applied to your final utility bill for that address/service location. Your digital signature below is your agreement to these terms.

  5. Leave This Blank:

  6. This field is not part of the form submission.