Service Request

SERVICE REQUEST

Ready to start your service? Please complete the following form and your service can begin within a week!

Requests may be submitted 24 hours a day, 7 days a week. We will respond during normal business hours of 8am - 4pm.

For the fastest response, simply fill out the form below and click "Submit".

* denotes required field

Contact Information:

Company Name:

*First Name:

*Last Name:

*E-Mail:

*Verify E-Mail:

*Phone:

Service Requested:

Sticker Service - Automated

Sticker Service – Vacationer

Sticker Service – By Request

Automated Service

Service Address:
Please include the service address. Also indicate if this will be curbside or door service. If door service, indicate the door at which the trash should be picked up.

*Address 1:

Address 2:

*City:

*County:

*State:

*Zip Code:

*Phone:

Service: Door Curbside

Which Door?

Payment Information:
Please indicate the method of payment that you plan to use.

Method of Payment:
Check/Money Order

Visa/Mastercard/Discover/American Express

COD

Billing Address: Same as service address.

If not same as service address, please complete the following:

Address 1:

Address 2:

City:

State:

Zip Code:

NOTE: After your request has been received, we will contact you during normal business hours to process your payment. Please have your method of payment ready if paying by credit card. If paying by check/money order, please send your payment to:

Prestige Refuse & Recycling, LLC
P.O. Box 265
Partlow, VA 22534
540-895-4083
service@prestigerefuse.com

Company Name:
*First Name:
*Last Name:
*E-Mail:
*Verify E-Mail:
*Phone:

	Sticker Service - Automated
	Sticker Service – Vacationer
	Sticker Service – By Request
	Automated Service

*Address 1:
Address 2:
*City:
*County:
*State:
*Zip Code:
*Phone:
Service:	Door Curbside
Which Door?

	Check/Money Order
	Visa/Mastercard/Discover/American Express
	COD