Start New Service

Choose your service, complete the form, and securely pay the required $75 startup fee through PayPal. Your request is created only after payment is confirmed.

Your information

First Name *

Last Name *

Email *

Mobile Phone *

Alternate Phone

Service address

Street Address *

City *

State *

ZIP *

Billing Address

Matches your street address. Click Modify to enter a different billing address.

Service details

Service Plan *

Requested Start Date *

Special Instructions

I agree to the service terms. *

I consent to email and service notifications.

Required startup fee

Securely processed by PayPal. Your request is submitted after successful payment.

$75.00

Payment submits a pending service request for team review. Service begins only after Patriot Disposal confirms your requested start date.