Service Type
*
Standard Service (1 clean/month)
Premium Service (2 cleans/month)
One-off Clean
Bin Types
*
General Waste
Recycling
Garden Waste
Other (please specify)
*
General Waste Bins
*
Please Select
1
2
3
4
Recycling
*
Please Select
1
2
3
4
Garden Waste
*
Please Select
1
2
3
4
Other
*
Please Select
1
2
3
4
Add-ons (One-off)
Food Bin Clean
Add-ons (Subscription)
Food Bin Clean
Bin Collection Day
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date of Next Collection (General Waste)
*
-
Day
-
Month
Year
Date
Date of Next Collection (Recycling)
*
-
Day
-
Month
Year
Date
Date of Next Collection (Garden Waste)
*
-
Day
-
Month
Year
Date
Date of Next Collection (Other)
*
-
Day
-
Month
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Special instructions
Total Bins
Total per month (£)
Total Price
Subscription Add-on total
Base Price (£)
One-off Add-on Total
Charge Amount (£)
Subscription Approved
Subscription ID
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Payment Amount
*
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