Ripple Glass

Name of the business or organization:

Business address:

City:

State:

MOKSILGA

Your first name:

Your last name:

Phone number:

Email address:

Relationship to business/organization:

Do you or your business own the parking lot where you would like to host a Ripple Glass bin?

NoYes

Do you currently have space available to place a 20ft Roll-Off Bin?

*about one parking spot*

NoYes

Does your lot have security cameras or overnight security services?

NoYes

How soon would you like to host a bin?

ImmediatelyNext monthIn the next 6 months6+ months from now