Home Our City Departments Finance Accounts Receivable Roll-Off Rental Application Roll-Off Rental Application Edit Form CITY OF DUMAS ROLL OFF RENTAL APPLICATION & DEPOSIT PAYMENT INITIAL DEPOSIT REQUIRED IS $150.00 ($100.00 REFUNDABLE, $50.00 NON-REFUNDABLE DELIVERY FEE) FEES AS DEFINED BELOW WILL BE CHARGED EVERY TIME THE ROLL OFF IS DUMPED $25.00 RETURN DELIVERY FEE (AFTER 3 LOADS) $200.00 PER DUMP PLUS $36.00 PER TON FOR WEIGHTS OVER 1 TON $5.00 INACTIVITY SURCHARGE PER DAY AFTER 3 CONSECUTIVE DAYS OF NOT DUMPING THE ROLL OFF REQUESTED DELIVERY DATE* DELIVER TO ADDRESS* Business Name Contact Name* Business Address* Billing Address* Cell Phone Business Phone* Home Phone Driver's License # Application Upload (Optional)? DEPOSIT PAYMENT OPTIONS $150.00 ($100.00 REFUNDABLE, $50.00 NON-REFUNDABLE) If you would like to pay by check or cash, please bring your payment to City Hall, 124 W. 6th Street, Dumas, TX 79029. If you would like to pay your deposit by credit card, please fill out the information below. We will then run the card at City Hall and have your receipt available there or email you a receipt if you input your email address below. Email Address Full Name on Credit Card Credit Card Type Visa Mastercard AMEX Discover Credit Card Number Expiration Date Security Code (Three Digits on Back of Card)? Billing Zipcode for Card BY CLICKING THE SUBMIT BUTTON, I AM CONFIRMING I HAVE READ AND UNDERSTOOD THE CITY OF DUMAS ROLL-OFF RENTAL APPLICATION REQUIREMENTS, AND I ACCEPT THE TERMS. I ALSO UNDERSTAND THAT THE SOLID WASTE SUPERVISOR IS AUTHORIZED TO WITHHOLD OR SUSPEND APPLICATIONS FOR ANY INDIVIDUAL WHO FAILS TO PAY ANY INDEBTEDNESS TO THE CITY WHEN DUE. IF I HAVE FILLED IN THE CREDIT CARD INFORMATION, I AM AUTHORIZING THE CITY OF DUMAS TO CHARGE $150.00 ($100.00 REFUNDABLE, $50.00 NON-REFUNDABLE) TO THAT CREDIT CARD IMMEDIATELY. Signature*? Date Field*