Vacation Form For Trash Collection printable pdf download

Vacation Form For Trash Collection

Village of Spencerville

“Vacation” Form for Trash Collection

In order for the Village of Spencerville Utilities Department to monitor those that request a “Vacation”

from their regular trash collection, the Village has implemented the following policy and procedure:

Customers who wish to have their regular trash collection temporarily stopped while they

are on vacation shall appear in person at the Village’s Utilities garage at 524 N. Broadway

Street or the Village’s Collection Agency, Reliable Plumbing, located at 112 S. Broadway

Street, to complete the appropriate “Vacation” Form for Trash Collection.

“Vacations” for regular trash collection shall be for a minimum of one (1) full month and

shall be in full month increments above and beyond the initial month.

“Vacation” start and end dates shall be provided at the time of requesting the service be

temporarily stopped.

The customer is solely responsible for notifying the Village’s Utilities Office and/or the

Collection Agency, of any changes to the dates provided on the original “Vacation” Form

for Trash Collection. The notification shall be in writing.

Upon successful completion and approval of the “Vacation” Form for Trash Collection, the

Village of Spencerville shall waive all charges associated with regular trash collection, for

the time specified on the “Vacation” Form for Trash Collection.

By signing below, I acknowledge that I have read and agree to the terms and conditions explained above.

Furthermore, I understand that failure to comply with said terms and conditions may result in loss of

privileges for future participation in the program for trash collection “Vacations”.

____________________________________________

___________________________

Signature

Date

Account Number: ________________________________

Name: __________________________________________________________________

Address: ________________________________________________________________

City: ___________________________________

State: ________________

Zip: _____________

Home Phone: ____________________________________________________________

Cell Phone: ______________________________________________________________

End Trash Service On: _______________________________________

Begin Trash Service On: ______________________________________

Vacation Form For Trash Collection