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WE GLADLY ACCEPT VISA, MASTERCARD, AND AMERICAN EXPRESS

Cardholder Name_________________________ California Waste Customer #_________________

Check here if you would like us to automatically charge your account every month. *

PERSON TO CONTACT TO CONFIRM CHARGE ____________________________

PHONE NUMBER _______________________________________________________

BEST TIME TO CALL_____________________________________________________

Authorizations for “One Time” charges to your account will be charged upon receipt of authorization.

*Automatic monthly Charges will be charged on the 15th of each month, to cancel just call the number below.

FAX FORM TO
CALIFORNIA WASTE RECOVERY (209) 369-2703