Laserfiche WebLink
Sales Representative <br /> SO L U T 1 0 N S Service Agree.AtIAAG <br /> Account 1 Site Number <br /> Service Address <br /> Name Daytime Phone No. Fax No. <br /> Forsaken Tattoo 209-594-7006 <br /> Address Email <br /> 13463 A Hwy 88 forsakentattoo@ymail.com <br /> City/State/Zip Code Contact <br /> Lockeford,Ca.95237 –i–0A1 <br /> Billing Address(If different than above) <br /> Name Daytime Phone No. Fax No. <br /> Forsaken Tattoo 209-594-7006 <br /> Address Email <br /> 13463 A Hwy 88 forsakentattoo@ymail.com <br /> City/State/Zip Code Contact <br /> Lockeford,Ca.95237 –�— <br /> Services to be Provided by Waste Stream Solutions <br /> Service Frequency Additional Pick Up Charge Additional Services <br /> 4x Per Year $145.00 if requested by client only ❑Dental Waste ❑Pharm ❑Chemo Path <br /> Maximum#of Waste Containers Medical Waste Container Size Charge Charge Charge <br /> up to 38 gal sharps and bio Medium NA NA NA <br /> Each Additional Container Charge Billing Cycle Amount Billed Per Cycle Price/Container Price/Container Price/Container <br /> $35.00 per container if over 38 gal Per Pickup 1$145.00 NA When requested NA <br /> By signing below I affirm that I am authorized,the authorized officer or agent of the Customer and have the authority to bind the Customer to this Agreement.The Customer <br /> hereby agrees to be bound to the terms and conditions that appear on the second page hereof and comply with Waste Stream Solutions'Waste Acceptance Policy,both of <br /> what are integral parts of this Agreement <br /> Contract Effective Date Customer Initials <br /> Customer Date Name(print) Title <br /> u4*1tIO-7-7— Z / `7'rJW (2)V 0LV-' <br /> Waste Strea olutio s Agent Date Name(print) Title <br /> 02/19/2013 Aldo Gonzalez Regional Accounts Manager <br /> Waste Stream solutions reserve the right to deal solely with the customer and not with any third party agents of the customer for all purposes relating to this agreement. <br /> Customer represents and warrants to Waste Stream Solutions that it is the medical waste generator and is acting for its own account and not to avoid liquidated damages, <br /> in the amount set forth herin for Customer's breach of representation and warranty. <br /> Promo Code: <br /> RON <br /> SEDC Record Number. <br /> EPA Gen ID# <br /> PO Box 1015 Claremont,CA 91711-Phone:600-550-0559 <br />