PURCHASE A WASTE COLLECTORS LICENSE

Information Required for Waste Collectors License
Name of Waste Collector's Company
Company Address
Primary Contact Phone
Email Address
If Company is a Corporation list directors and officers
Title
Name
Address
Vehicle Information
Number of vehicles Requiring Permit IDs under this License
Make *
Model *
Year *
License Plate # *
Tara Weight
Make
Model
Year
License Plate #
Tara Weight
Make
Model
Year
License Plate #
Tara Weight
Make
Model
Year
License Plate #
Tara Weight
NOTE: License shall notify license issuer of any change of information supplied with in five(5) business days of a change
List Waste Collection Routes in New Haven
Route
Est. Start Time
Est. End Time
Route
Est. Start Time
Est. End Time
Route
Est. Start Time
Est. End Time
Route
Est. Start Time
Est. End Time
List other municipalities where your business collects refuse:
1
2
3
4
5
6
7
8
9
Payment Method

Check Credit Card
Amount
Name

First

Last
Card Number
CVC
Expiration Date

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Information Required for Waste Collectors License