North Lincoln Sanitary

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Vessel Sizes		96 Gallon		64 Gallon	32 Gallon


Vessel Location		Roadside Service		Carry Out Service

Frequency	Once Per Week		Every Other Week		Once Per Month

Transfer Service to New Address	New Serivce Address

	Start Date - 1st pick-up date


Cancel Service		Old Service Address

		Cancellation Date - last pick-up date

I'm interested in EasyPay*		*EasyPay is our online automatic payment option. With EasyPay, you can eliminate the hassle of writing checks and buying stamps.

Security Deposit For This Order* *This amount is an estimate. The actual amount of your security deposit may be higher or lower. We will be in contact with you for payment.

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Vessel Type		96 Gallon		Cardboard Container


Vessel Location		Roadside Service		Carry Out Service

Frequency	Once Per Week		Every Other Week		Once Per Month

Transfer Service to New Address	New Address

	Start Date - 1st Pick-up Date

		Items(s) Description

Cancel Service		Service Address

		Cancellation Date - Last Pick-up Date

I'm interested in EasyPay*		*EasyPay is our online automatic payment option. With EasyPay, you can eliminate the hassle of writing checks and buying stamps.

Security Deposit For This Order* *This amount is an estimate. The actual amount of your security deposit may be higher or lower. We will be in contact with you for payment.

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Vessel Types		10 Yard		20 Yard
		30 Yard		40 Yard
			Dump Trailer



Drop Off	Date

Pickup	Date

	I will call for pickup (541-994-5555).

Security Deposit For This Order* *This amount is an estimate. The actual amount of your security deposit may be higher or lower. We will be in contact with you for payment.

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Pickup Date:

Description:

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Purchase Containers			1 Gallon:

			35 Gallon:

Schedule Pickup			Pickup Date:

			Description:

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

Drop Off Date

Pickup Date

		I will call for pickup (541-994-5555).

A copy of this request will be sent to the provided email address.

Name:				Phone:
Billing Address:				Email:
Service Addres:				Account Number:
Check if Billing Address is Same as Service Address.
I don't have an account with North Lincoln Sanitary.

Order New Service

A copy of this request will be sent to the provided email address.

Dear Drop Box Customer,

Please review and confirm by your signature below that you have read and understand the requirements and restrictions for drop box use.

NLSS offers the following Drop Box Sizes in cubic yards: 10, 20, 30, and 40.
The Drop Box needs to be emptied at least once every 7 days. On the 8th day a $20/day demurrage will be added. The boxes can be used for disposal of bulky materials, light demolition, tree trimming, or other general cleanup projects.

If you are disposing of dirt, rock, sod, concrete or any other heavy dense material, a 10 cubic yard drop box is the only size we can allow.
If you are disposing of composite (3 tab, asphalt shingle) roofing material, then a 20 cubic yard drop box is the largest size we can allow.

Unacceptable items in any drop box include but may not be limited to the following:

E-waste (TVs, computers, and computer monitors)
Liquids that will pass through a paint filter
hazardous materials (i.e. liquid paint, liquid pesticides, liquid chemicals, asbestos, vehicle batteries)
infectious waste, medical waste, or radioactive waste as defined by applicable by state, federal, or local laws or regulations
The following items banned from Landfills may be placed in a drop box, but NLSS needs to be informed:
- Large Appliances (refrigerators, stoves, heaters) - Place at front of box.
- Tires - Place at back of box.

Overweight or overfilled boxes can be subject to additional fees and may require removal of materials by the customer before the box can be hauled.

As a drop box customer you will be responsible for all fees incurred including delivery, haul, disposal and may include additional fees such as: rent, damage to box, testing, clean up, abatement of unacceptable items, etc....

All Construction and Demolition debris must be accompanied with documentation proving the load does not contain asbestos-containing material - a Construction and Demolition Waste Acceptance Form. If any material in the box could be considered suspect for Asbestos-Containing Material (ACM), including but not limited to flooring, sheetrock, duct work, roofing material, plaster, popcorn ceiling, or anything else that looks like it came from a remodel or demolition, the hauler and/or disposal site may refuse the box until the customer can provide documentation proving the load does not contain ACM. If a box is picked up and undeclared, suspect, ACM is discovered at the transfer station, the customer will be charged for all cleanup costs.
Cleanup could range in the thousands of dollars.

When did the construction, demolition, or renovation materials originate from the structure or RV?

Was the material constructed after Jan 1, 2004?

Is the material bare wood, glass, or three tab compostion shingles with no tar paper?

Was the material constructed before Jan 1, 2004?

Was an asbestos survey conducted?

Yes. - If yes, attach the survey. A survey was conducted, if there was any asbestos containing materials (ACM), they were identified in the survey. By submitting this form, I attest that the ACM materials are not present in this load.

No. - If no, a survey must be conducted on construction, demolition, or renovation debris constructed before Jan 1, 2004. We are sorry, but we cannot accept your load without a survey.

Upload Asbestos Survey:

By checking this box, I attest that no asbestos survey is required, as the construction, demolition, or debris materials were either constructed on or after Jan 1, 2004 or contains only bare wood, metal, glass, or three tab composition shingles with no tar.

By adding my name to this form, I warrant that the information provided is truthful and accurate to the best of my knowledge and agree that this shall act as an electronic signature in place of a hand-written signature. If you would like to fill out a pdf version of this form instead, click here.

Your Liability Release Form was sent!

Click the image below for a printable PDF.