Contract Sign Up

Use the form below to sign up for contract service at one of the campgrounds we provide pumping services for.

If you aren’t up for filling out your contract online, you can print, fill out and scan/email, mail or drop it off at our liquor store.

Download PDF Contract

Name

Email Address

Phone 1

Phone 1 Type

Phone 2

Phone 2 Type

Campground

Lot Number

Camper Year

Camper Make

Camper Model

Connections

Black Handles

Grey Handles

Start Date

End Date

Service (See contracts page for details of each service) Service (See contracts page for details of each service) Restroom Rental: $50 / 4-weeks Camper Pump: $50 / 4-weeks Own Restroom Service: $50 / 4-weeks On-Demand Camper Pump: $35 each On-Demand Own Restroom Service: $35 each

Comments

Contact Preference Contact Preference Email Phone

Invoice Preference Invoice Preference Email Snail Mail

Billing Name

Street

City

State

ZIP

11 + 15 =