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Customer Account No. NEW <br />NAICS Code <br />Reason Code NEW <br />Effective Service Date <br />Max Weight Per Yard <br />Service Agreement <br />Non -Hazardous Wastes <br />Account Name Cool Runnings Restaurant and Bar <br />Billing Address 129 N Michigan Street <br />City, State, Zip Code _ <br />Tel # 574-202-1893 <br />South Bend, IN <br />E-mail J.smithnasb@gmail.com <br />Contact Jason Smith <br />Fax # <br />446011111- <br />Hrii <br />A Waste -Away Group, Ltd. Company <br />Himco Waste -Away Service, Inc. <br />707 North Wildwood Ave Post Office Box 1278 <br />Elkhart, Indiana 46514 Elkhart, Indiana 46515 <br />Phone:(574)293-8534 (800)634-4626 <br />Fax: (574) 294-7010 <br />Website: www.WasteAwayGroup.com <br />Equipment & Service Specifications <br />Site Address Qty Size Type Lids Wheels Lock Freq Service Day(s) <br />SAME 1 3 T / / / x/w <br />Special Instructions <br />Waive Delivery Fee <br />Site: In the sabe Cubby as Woochie's containers <br />THE UNDERSIGNED INDIVIDUAL SIGNING THIS AGREEMENT ON BEHALF OF THE CUSTOMER ACKNOWLEDGES <br />THAT HE/SHE HAS READ AND UNDERSTANDS THE TERMS AND CONDITIONS OF THIS AGREEMENT, ON THE <br />REVERSE SIDE, AND THAT HE/SHE HAS THE AUTHORITY TO SIGN ON BEHALF OF THE CUSTOMER. <br />Customer <br />(AUTHORIZED <br />r <br />Total: <br />Charge(s) <br />Schedule of Charges <br />Casters / Locks per Month <br />$ <br />Extra Pick -Up Charges <br />Per Lift If needed <br />$ 100.00 <br />Per Lift <br />$ <br />Per Lift <br />$ <br />Transportation Per Load <br />$ <br />Transportation Per Load <br />$ <br />Transportation Per Load <br />$ <br />Disposal Per Ton <br />$ <br />Loose Yard Extra Per Yard <br />$ 50 <br />Container Delivery, Removal, Exchange Fee _$ <br />150 <br />Container Relocation Fee <br />$ 75 <br />Minimum Monthly Charge <br />$ .110 <br />Demurrage Charge Per Minute After _ Minutes $ <br />Monthly Equipment Service Charge <br />$ <br />Terms: Net 10 Days <br />Himco Representative <br />Austin Maddux <br />(AUTHORIZED SIGNATURE) <br />(TITLE) <br />NAME (PrintorType) <br />White(Original) - File Yellow - Customer <br />(TERRITORY) <br />Pink - Sales <br />(DATE) <br />(Rev 08/2017) <br />