Domestic customer registration Domestic Form If you are human, leave this field blank. Customer name * Address * Postcode * Phone number * Email Address * Number of Black Bins (General Waste) at premises? * 0 1 2 3 4 5 More Clean Cycle for Black Bins (General Waste)? * N/A 2 week cycle 4 week cycle 6 week cycle 8 week cycle 10 week cycle Ad-hoc / one-off wash Number of Blue Bins (Mixed Recycling) at premises? * 0 1 2 3 4 5 More Clean Cycle for Blue Bins (Mixed Recycling)? * N/A 2 week cycle 4 week cycle 6 week cycle 8 week cycle 10 week cycle Ad-hoc / one-off wash Number of Brown Bins (Food & Garden Waste) at premises? * 0 1 2 3 4 5 More Clean Cycle for Brown Bins (Food & Garden Waste)? * N/A 2 week cycle 4 week cycle 6 week cycle 8 week cycle 10 week cycle Ad-hoc / one-off wash 'Put Out' service required? * Yes No This is a service that can be utilised by our clients that go on holiday or have aged parents or have sustained an injury that makes it difficult to put your bin out. Your bin will be put out for emptying the night before and then returned to an agreed location after cleaning. We will complete an assessment of your property and confirm suitability and cost. Comments? Submit
