Schedule Septic Pumping

First Name:

 

Last Name:

 

Street Address:

 

City/State/Zip:

 

Phone #:

 

Email:

 

How would you prefer to be contacted? Email or Phone:

 

New or Existing Customer:

 

Payment:

 Cash

Check

 VISA

 Mastercard

 Discover

 

Nearest Cross Street:

 

Tank Location (if known):

 

Tank Volume (gallons):

 

Is the cover exposed?:

 Yes

 No

 

Last time pumped (if known):

 

Are you experiencing any septic problems?:

 Yes

 No

 

Comments:

 

Request date to pump:

 

Note:  We will contact you to discuss payment arrangements before the date of service and to confirm your appointment.  By clicking the “submit” button, you agree that you are the owner or the duly authorized agent of the premises and accept full responsibility and that you represent and affirm you are of legal age.

 

We thank you for your business and will be in contact with you soon.

 

 

 (When you hit “submit”, your email should open with the information you entered in the body. Send the email and the appropriate person will contact you.)

 

6380 Main Road Stafford, NY 14143 | Office: 585-343-2910| Fax: 585-343-8147