Form Center

2. Customer Name
   (Hereinafter referred to as the Customer)
3. Date
   Date
5. Agreement
   I, the Customer, for the provision of dumpster (temporary container) services by the City of Zephyrhills will at all times indemnify, save, and hold harmless the City of Zephyrhills, its officials, agents, and employees (hereinafter referred to as Zephyrhills) from all liability, claims, attorney fees at trial or appellate levels, and all court costs arising out of damage to any and all property, including the loss of use therefore resulting from or in any manner arising out of or in connection with any storage, use by the Customer and removal of the dumpster at the following location by Zephyrhills. The Customer further agrees to pay in full for all services rendered and billed accordingly by Zephyrhills, its agents, subcontractors, servants, or employees.
7. Location of Dumpster
9. Electronic Customer Signature
10. Account Number (if City Resident)
12. Customer Address
14. Customer Phone Number
15. Customer Email Address
17. Disclaimer
    The City of Zephyrhills shall not be responsible for damage to lawns; fences; shrubbery; or cracked or broken sidewalks, walkways, or driveways that may occur as a result of the delivery or pick-up of a temporary dumpster. Dumpsters shall not block sidewalks, roadways, or be placed within the public right-of-way. It shall be the responsibility of the property owner to be on-site at the time of delivery and designate a proper location for the delivery of the dumpster. The Sanitation Division may refuse delivery if access to the delivery site is unsuitable for solid waste type vehicles.
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field