Below please see the credit card authorization. We will charge the credit card the first (delivery, pick up
and disposal) container amount plus tax prior to the initial drop off. Once the credit card authorization
has been received and processed, we will schedule delivery. Subsequent swap outs will be charged to the
same credit card at the agreed upon rate including taxes, weight overage and days overage. Client accepts
all responsibility for due diligence of jurisdictional agreements with other container service providers,
should one exist.
UNACCEPTABLE MATERIALS /Any hazardous materials including but not limited to asbestos containing
materials, paints, liquids of any nature, solvents, septic tank pumping, sludge's, dead animals, fluorescent
light bulbs, electronics, and tires. You will be charged based on the charges applied by the landfill for
unacceptable materials.
CREDIT CARD AUTHORIAZATION / Please complete all fields. You may cancel at any time by contacting
us. This authorization will remain in effect until cancelled.
Service Address:______________________________________________________________________
Company Name:/Contact:________________________________________________________________
Contact Phone:/Email:___________________________________________________________________
Card Type: Master Card □ Visa □ Amex □ Discover □
Cardholder’s Name as shown on card:______________________________________________
Card Number:_________________________________________________________________
Expiration Date: (mm/yy)_________________________________________________________
Security Code:__________________________________________________________________
Zip code of billing address:________________________________________________________
I,_______________________________, authorize M3 Disposal to charge my credit card above for
agreed upon purchases. I understand that my information will be saved on file for future transactions
on my account.
Kevin Dalton
817.522.6902 / kevin@m3disposal.net