1.Customer Legal Name
2. Primary Phone Number
3. Alternate Phone Number
4. Date Of Birth
5. Last 4 Digit of Social Security Number
6. Drivers License Issued In Which State
7. Drivers License Number
8. Email Address
9. Physical Address For Service
10. Mailing Address
City
 State
 Zip Code
11. Do You Rent Or Own The Service Property
12. If Renting List Landlord Name
13. Texting Phone Number For Notifications
14. Do You Have Any Current Liens, Judgements or
Encumbrances
Yes
 No
If You Have Any Current Liens, Judgements or
Encumbrances Please List State and County
15. Have You Ever Filed Bankruptcy
Yes
 No
16. How Did You Learn About Express Disposals
By entering your name in the below box, you authorize Snyder Transport, Inc DBA: Express Disposals to obtain information on you and or your business and principal owners from consumer credit bureaus and others for the sole purpose of extending credit and
authorize any party receiving a credit inquiry from Snyder Transport, Inc DBA: Express Disposals to release any information requested.
All Applicants:
For and in consideration of the extension of credit for rental and services, the undersigned applicant agrees to:
→ Pay stated amounts DUE within stated terms for rental and services and applicant understands that credit will be suspended at the option of credit grantor for payments not so paid.
→ Invoices are not pro rated for service
→ $35.00 delivery & pick up fee may apply
→ Pay the late fee on all past due amounts accruing from the date of the invoice at a rate of eighteen percent (18%) per annum or, if less, the maximum rate allowed by law.
→ Pay credit grantor any handling fees associated with returned check(s) from applicant.
→ In the event applicant fails to pay credit grantor all amounts due hereunder, credit grantor will be entitled to collect all reasonable costs of collection, attorney fees and court costs.
→ Customer understands that all provided garbage receptacles are owned solely by Snyder Transport, Inc DBA: Express Disposals and customer will agree not to alter, modify, and improve garbage receptacles without written consent by Snyder Transport, Inc
DBA: Express Disposals.
→ Indemnity- The "Customer" receiving service by Express Disposals agrees to indemnify, defend, and save Snyder Tramnsport, Inc. or Express Disposals Dumpsters harmless from and against any and all liability which the equipment may be responsible for
or pay out as a result of bodily injuries (including death), property damage or any violation or alleged violation of the law to the extent caused by "Customer's" breach of this Agreement or by any negligent omission or willful misconduct of the "Customer" or its
employees, agents, or contractors in the performance of this agreement. Neither party shall be liable to the other for consequential, incidental, or punitive damages arising out of or in connection with the performance or non-performance of this agreement.

The above information is correct to the best of my knowledge and I am authorized, in my capacity, to bind my firm accordingly. I understand and agree to the terms of this application. I represent that I have the financial ability and willingness to pay all invoices
within established terms.
Type Full Name
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By clicking Acceptance and Submit You Acknowledge And Understand You Are Entering Into The Above Terms And Agree
//EXPRESS DISPOSALS
840 Olds Rd.
P.O. Box 812
Douglas, Wy 82633
Residential Application for Service
Please Provide The Answers For The Following 16 Questions. All 16 Questions MUST HAVE EACH FIELD ANSWERED prior to you clicking the terms Accept and Submit button.
Understand if all questions are not filled out then our server will reject the application and no trash receptacle will be delivered.  If You Have Any Questions Fill Free To Contact Us.
We Thank You For Your Time And Look Forward To Servicing Your Disposals Needs