Agreement & Release Form

Complete and submit the form below electronically OR you can download our printable form, complete and drop off, mail or fax to our office.


                This Agreement is made on the date selected below; from this date forward by and between PERRY’S SOLID WASTE DISPOSAL, (hereinafter “Company”) and is subject to the following terms and conditions.
    1. A bill will be sent directly to the Customer for services rendered.  Customer hereby agrees to pay said bill in full within thirty (30) days of receipt.  In the event Customer fails to pay said bill within thirty (30) days Company may pursue legal action to collect the unpaid balance.  All costs and expenses associated with these proceedings, including but not limited to interest, attorney’s fees and court costs, shall be paid by the Customer.
    1. Customer represents and warrants that he/she has been advised and understands that damage may occur to the property and/or surroundings where the container is being delivered, which is beyond the control of the Company and/or its agents.

    Roll-off containers cannot have LP tanks, batteries, large appliances, tires, oil or wet paint (open cans and place sand or saw dust inside) placed in them – nothing over 8’ can be placed in the can – No metal – contents must be level with top of container (if rocks or concrete only half full) – any stumps in the container - the landfill will charge more per ton.  There will be a $300.00 charge if containers needs to be sorted for items placed inside that should not have been.

    Front load containers (2yd, 4yd, 6yd & 8yd) are for long term use only (1 year or more).  If service is canceled before the year is up there will be a cancellation fee.

    1. Release and Indemnity. Customer hereby releases, discharges, indemnifies and holds harmless the Company, its successors, agents, assigns, employees and representatives from any and all claims, demands, damages, actions or suits of any kind whatsoever and including but not limited to damages causes while dropping off or picking up containers, as a direct or indirect result of Customer’s use of services furnished by Company.
    WITNESS OUR SIGNATURES, the day and year selected below.
  • MM slash DD slash YYYY
  • To be completed by Perry's Solid Waste Disposal Representative:

    By: _____________________________

    ________________________________ Printed Name