To Start New Service, please complete the following information:** You must be 18 years or older to request service and by completing this form you acknowledge that you (and spouse, if applicable) are the responsible party(ies) for all charges associated with this new account.Have you ever had service with Southern Oregon Sanitation before?* Yes NoWhat date would you like your service to start?* MM slash DD slash YYYY Name* First Last Middle Initial*Last 4 digits Social Security #*Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your Spouse's name (if applicable)Main Phone*Cell PhoneEmail* Service AddressService Address*Service City*Select your cityGlendale, ORReedsport, ORButte Falls, OREagle Point, ORGold Hill, ORProspect, ORRogue River, ORShady Cove, ORCave Junction, ORGrants Pass, OROther (Please specify)Other locationService Zipcode*Do you rent or own this property?* Rent OwnBilling InformationBilling Address same as Service?* Yes NoBilling Address*Billing City*Billing State*Billing Zipcode*Trash Cart Size* 35gal 65gal 95galSelect Service Interval* Once a week service Every other week serviceAre there existing carts you would like to assume at this service address? Yes NoCommingle Recycle Service:Include Commingle Recycling Service? Yes NoIf available in your area, include Commingle Recycle Service? Yes NoYard Debris Recycle Service:Include Yard Debris service? Yes NoJoin us in our effort to reduce paper usage by signing up to receive electronic billing statements and notifications.Go Paperless Yes, I would like to go paperless and receive electronic statementsPlease contact me via: Email PhoneThe best time to contact me via phone is: : Hours Minutes AMPM AM/PMPlease select a time during our normal business hours between 8 am and 5 pmSecurity Check
