2. The undersigned hereby certifies to the City Clerk of Hebron, Nebraska that:
6. has been selected as the private garbage collector to serve the residential/commercial location identified below.
8. Service will begin
10. Customer
11. Date
    Date
13. Residential/Commercial Location
15. Bel-Con. Sanitation- $15.75 per month includes toter, picked up on Thursdays.
17. Garbage Co. South- $15.75 per month includes toter, picked up on Tuesdays.
21. Electronic Signature:*
    Please type your First and Last Name
22. Date*
    Date

    Date
24. Agreement

    1. I understand

    I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit Submit and Print

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