Garbage Service Application (City Resident Only)

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Name on Account: *

Date for Service Activation DO NOT CHOOSE A WEEKEND OR HOLIDAY:

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New services activations are only available Monday - Friday DO NOT CHOOSE A WEEKEND OR HOLIDAY

Garbage Can Size *

95 Gallon (Standard size)

65 Gallon

Email Address: *

Service Address: *

Mailing Address: *

City: *

State: *

Zip Code: *

Cell Phone #: *

for example 000-000-0000

Driver License: *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp pdf doc docx.

Proof of Ownership/Lease Agreement *

Provide proof of ownership or rental/lease agreement
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp pdf doc docx.

Authorization Agreement For Direct Payments (ACH Debit):

Checking Account

Saving Account

I (we) hereby authorize CITY OF DAWSONVILLE, hereinafter called COMPANY, to initiate debit entries to my (our) Checking Account or Savings Account indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Authorization For Direct Payments (ACH Debit)

Please upload a VOIDED CHECK from your banking institution.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Depository (Bank) Name:

Employer: *

Routing Number

Account Number

Work Number #: *

for example 000-000-0000

Name of Emergency Contact: *

Emergency Contact Number #: *

Terms and Conditions: *

Yes Weekly Garbage Service $19.90/month. Each customer will be billed for the previous month's garbage service. The customer will be responsible for that month's bill whether they receive a bill or not. Please contact City Hall (706) 265-3256 if you do not receive a bill. Payment for Garbage Service is due upon receipt each month. A $10.00 late fee penalty is charged on all late payments after the fifteenth (15th) of each month. When I move, I will submit a termination form to the City of Dawsonville at least three (3) days in advance. $60.00 refundable deposit required at the time this application is made, plus an administration fee of $15.00 for a total due of $75.00 All Returned Check will have a Returned Check Service Charge of $35.00. All fees and rates are subject to change.

Authorization for DEPOSIT- ONE TIME CHARGE

I (we) authorize CITY OF DAWSONVILLE, hereinafter called COMPANY, to process a ONE TIME CREDIT CARD PAYMENT of $75.00, plus a 3% processing fee, to be applied to the deposit for requested service(s). This is a ONE TIME charge and DOES NOT establish a recurring payment. Please enter a valid credit card number and the 4-digit expiration date. i.e., 01/21.

Signature: *

Date:

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Message

Garbage Service Application (City Resident Only)

Contact Information