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Agreement For Pick Up Of Large Items






A $15.00 fee will be paid for large item pick up (i.e. furniture, appliances, no tires or paint cans). If I cancel the pick up the $15.00 fee will be returned to me.


I will be billed the tipping fee by the Village of Fultonville and agree to pay said bill within thirty (30) days. If the bill is not paid within thirty (30) days a 10% penalty will be accessed. Thereafter for every thirty (30) days unpaid another 10% penalty will be accessed.


I,                                                          , have read and agree to the above agreement.




            Signature                                                                                                   Date






Item/items to be picked up:                                                                                                   




Scheduled pick up date:                                                                                                         


Paid:    Cash                            Check #                      


Approved by:                                                                                                                         


Tipping Fee Paid                                 

4/17/2018 2:08:16 PM