New Customer Signup | Cottage Grove Street Transfer Station

Company / Account Information

Company / Business Name *

DBA (if applicable)

Type of Business *

Primary Contact Name *

Title

Years in Business

Business Phone *

Cell Phone

Email *

Billing Address *

Service / Job Site Address (if different)

Tax ID / EIN (optional)

Payment Method

ACH / Bank-to-Bank NO FEE

Charges drafted directly from your business checking or savings account. Recommended.

Credit / Debit Card 3.5% FEE

A 3.5% processing surcharge applies to all credit and debit card payments.

ACH Bank Information

Bank Name *

Name on Account *

Account Type *

Routing Number (9 digits) *

Confirm Routing Number *

Account Number *

Confirm Account Number *

Please retype your routing and account numbers in the confirm fields (paste is disabled) to ensure accuracy. Your bank information is transmitted securely and stored only in our protected billing system. We may request a voided check for verification.

Card information collected separately by phone. For PCI security compliance we do not collect credit card numbers on this form. After you submit, our billing team will call you at the phone number above within 1–2 business days to securely take your card information.

Backup Payment Card — Required on File

Required: Backup Card on File

Whether you've selected ACH or Card as your primary payment method, we also require a backup credit or debit card on file in case an ACH payment fails (insufficient funds, account closure, returned payment, etc.). This ensures uninterrupted service.

Backup card information is collected securely by phone within 1–2 business days of approval — we do not collect card numbers on this online form for your protection.

The backup card is only charged when an ACH payment fails or for one-off charges you explicitly authorize. A 3.5% processing surcharge applies to any card charges.

I authorize Cottage Grove Street Transfer Station to collect my backup credit/debit card information by phone within 1–2 business days of my application approval. I understand a 3.5% surcharge applies to any card charges and that the backup card is only used when ACH payment fails or for explicitly authorized charges.

Payment Authorization & Electronic Signature

Payment Authorization

By signing below, I authorize Cottage Grove Street Transfer Station (a GMI Services company) to charge the payment method on file for all charges incurred — including tipping fees, scale fees, container rental, service charges, late fees, returned-payment fees, and other authorized charges. Credit/debit card payments incur a 3.5% surcharge; ACH (bank-to-bank) payments carry no fee. This authorization remains in effect until I notify Cottage Grove Street Transfer in writing of cancellation with at least 10 business days' notice.

Electronic Signature Consent (ESIGN Act)

I intend to sign this Customer Application & Payment Authorization electronically. My electronic signature is the legal equivalent of my handwritten signature and is fully binding on me, my company, and any successors.
This agreement, when signed electronically, constitutes a binding contract with Cottage Grove Street Transfer Station under the federal ESIGN Act (15 U.S.C. § 7001 et seq.), the Uniform Electronic Transactions Act (UETA), and applicable state electronic-signature laws.
I confirm my device and browser are capable of viewing this form and that I can save, print, or request a paper copy of this signed agreement at any time by emailing [email protected].
I have read, understand, and agree to all terms above before signing. I certify that all information provided in this application is true, complete, and accurate.
I understand that I may withdraw my consent to electronic signature by notifying Cottage Grove Street Transfer in writing, in which case a paper copy of this agreement will be provided for handwritten signature.

I have read and agree to the Payment Authorization and Electronic Signature Consent above. I understand that signing below is the legal equivalent of a handwritten signature and creates a binding agreement.

Draw Your Signature Below *

Printed Name *

Title

Date

Sign Up as a New Customer

Required: Backup Card on File

Payment Authorization

Electronic Signature Consent (ESIGN Act)