Aspinwall Return Form

TO ALL ASPINWALL PROPERTY OWNERS: Please take the time to complete this form. This will help us maintain up to date information for service, communication, and the waste industry’s government reporting requirements to your municipality:

Co-Cust#(This is the 10-digit number on your statement.)

Check the option that applies

I am the homeowner, and this is my primary residence

I am the tenant, and I rent this property

Customer Name

Billing Name(for landlords that use a corporate name)

Service Address

Service Address(House # and Street Address)

Service Address Line 2(Apartment or Unit Number)

Service City

Service State

Service Zip

Billing Address

Billing Address(if different from service address)

Billing Address Line 2(Apartment or Unit Number)

Billing City

Billing State

Billing Zip

Additional Information

Email address

Paperless Billing

Check this box if you would like to receive your bill via Email. By selecting this option, your next statement will be sent to you from [email protected]. If you do not receive your quarterly statement, please check your spam/detained folder.

Home Phone

Cell Phone

Authorized Additional Person on Account(Optional)

Authorized Additional Person Contact Number

Additional Contact Phone Type

Home

Cell

Work

Name of person filling out form