Start New Service

Choose your service, complete the form, and securely pay the required $75 startup fee by credit or debit card. Your request is created only after payment is confirmed.

Your information

First Name *

Last Name *

Email * Confirm Email *

Mobile Phone *

Alternate Phone

Additional Account Contacts

Add up to 3 additional people who can be contacted about this account.

Service address

Street Address *

City *

State *

ZIP *

Billing Address

Matches your street address. Click Modify to enter a different billing address.

Street Address

Address Line 2

City

State

ZIP

Service details

Service Plan *

Requested Start Date *

Special Instructions

I agree to the service terms. *

I consent to email and service notifications.

I agree to receive SMS text messages regarding my account with Patriot Disposal LLC and its services and billing. Message and data rates may apply; frequency may vary. I can opt out at any time by replying STOP, or get help by replying HELP. Terms & Conditions and Privacy Policy are at patriotdisposalllc.com.

I want to receive paperless billing and invoices by email.

Required startup fee

Securely processed by Stripe. Your request is submitted after successful payment.

$75.00

Payment submits a pending service request for team review. Service begins only after Patriot Disposal confirms your requested start date.