Welcome!
Thank you for choosing Environmental Septic Services.
Name
*
First Name
Last Name
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Service Contract Form
Hey there, Environmental Septic services here. Please complete out this form to select your service level, provide contact and payment information for your septic maintenance contract. After completion the contract will be created and sent to the county completely done for you. No Hassle.
Septic System Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from septic address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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Contract Start Date (if known)
-
Month
-
Day
Year
Date
Contract Length
*
1 year
2 years
Service Level
*
Basic
Gold
Platinum
Best Form of Communication
*
Email
Call
Text
Special Instructions - If you have a Dog in yard, gate code, etc.
Mention anything!
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Preferred Payment
Payment can be made via phone, Bank Draft (ACH), Card, Zelle and PayPal; or on our main website via "Pay Invoice". (Zelle available using our phone number (214-325-8028). All payment information is held privately, secured and never shared.
Preferred Payment Type
*
Bank Draft (ACH)
Credit / Debit Card
Pay over the Phone
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Bank Draft (ACH) Payment
All payment information is held privately and never shared.
Bank Account Number
*
For ACH draft
Routing Number
*
For ACH draft
Bank Name
*
Name of bank
Name on Account
*
First & Last Name
Signature
*
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Credit/Debit Card Payment
Coming Soon... for now please pay by card over the phone by speaking to the owner Lori, at 214-325-8028. All payment information is held privately and never shared.
Signature
*
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Phone Payment
By selecting phone payment and signing below you agree to receive a phone call from Environmental Septic Services collecting pay during Environmental Septic Services' normal servicing hours 8:00 AM to 5:00 PM Money through Friday. We are super friendly and love to talk any additional details on your account. Your contract will not go into affect until payment is collected. Thank you so much for choosing us.
Name on Account
*
First & Last Name
Number to call for payment
*
Signature
*
Submit
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