Bin Lead Qualification Form

To follow up on your referral, our team may reach out from one of these numbers. Please let the customer know which number to expect

• National -
(855) 439-6455 or (813) 492-7737
• Austin - (512) 500-0570
• Baltimore - (410) 995-7471
• Birmingham AL - (659) 208-2063
• Boston MA - (617) 514-0711
• Charleston - (843) 620-6087
• Charlotte - (704) 981-0682
• Chattanooga TN - (423) 565-6486
• Chicago - (312) 796-9929
• Cincinnati OH - (513) 273-0415
• Cleveland OH - (216) 343-0540
• Colorado Springs CO - (719) 204-3832
• Columbia SC - (803) 866-1609
• Connecticut - (860) 792-3106

• Corpus Christi TX - (361) 202-8608
• Dallas - (469) 903-2464
• Delaware - (302) 280-8638
• Denver - (720) 343-5753
• Detroit - (248) 550-0653
• Georgia - (678) 388-4311
• Houston - (832) 377-1966
• Huntsville AL - (256) 672-4050
• Indianapolis - (317) 942-0543
• Jacksonville FL - (904) 479-2816
• Kansas - (913) 289-0568
• Lexington Units - (810) 284-5250
• Little Rock AR - (479) 208-5961
• Louisville - (502) 579-8069

• Memphis TN - (901) 554-5646
• Milwaukee WI - (414) 420-1171
• Nashville - (615) 953-0026
• New Jersey (609) 244-0345
• New Mexico - (505) 376-6516
• New York- (631) 313-8450
• OKC - (405) 825-1990
• Orlando -(407) 564-6849
• Pensacola FL - (850) 360-6947
• Philadelphia - (267) 659-2529
• Phoenix - (602) 649-6185
• Pittsburgh - (412) 634-0655
• Providence RI - (401) 203-3766
• Raleigh - (909) 375-3673

• Salt Lake City - (801) 872-8872
• San Antonio - (210) 953-7766
• South Florida - (305) 315-2340
• Springfield - (413) 353-9793
• St Louis MO - (314) 279-5270
• Tampa FL - (813) 798-6943
• Virginia - (276) 212-4925
• Wisconsin - (262) 205-1108
• Worcester - (508) 375-3344
• Minnesota - (612) 412-1968

Answer the following questions to find out if you have a bin lead!

Internal use only — Roll-Off Sales Team lead qualification form.

This is for a Year or More of Dumpster Service(Required)

Not a bin lead — short-term dumpsters go to Roll-Off Department.

This is for compactable trash such as office, restaurant, or residential debris(Required)

Not a bin lead — non-compactable debris goes to Roll-Off Department.

The customer is needing a size 8yd dumpster or less(Required)

Not a bin lead — larger dumpsters are handled by Roll-Off Department.

Referring Sales Rep Name(Required)

First Last

Customer Name(Required)

First Last

Phone Number(Required)

Size(Required)

Debris Type(Required)

Permanent Placement Dumpsters Do Not Allow Construction Debris ** Sell a Roll- Off Dumpster**

Zip Code(Required)

ZIP Code