City of Austin - Dillo Dirt Vendor Application

Dillo Dirt Vendor Application Form 2008
* indicates required fields.

Date:	02/09/2012
Vendor Name:	*
Mailing Address:	*
City:	*
State:	*
Zip Code:	*

Physical Address (if different from mailing address):
City:
State:
Zip Code:
Central Texas Region:	*
Telephone:	*
Email:	*
What is your preferred method of communication?:
Company Web Site:
Do you want to sell Dillo Dirt to the public?:	Yes No
If you respond yes, we will add you to the public list on our website.

Truck Information
Vehicle:	*
Make:	*
Year:	*
License Number:	*
Hauling Capacity:	* in cubic yards.

Vehicle Two (if applicable)
Make:
Year:
License Number:
Hauling Capacity:	in cubic yards.

I have received a "Dillo Dirt Compost Marketing Agreement" and will comply with all requirements stated therein.

Name:	*
Title:	*
By clicking the "Submit application" button below, I am agreeing to the terms of this Dillo Dirt Vendor Application. I will fax a copy of my proof of insurance for the above truck to Jody Slagle at (512) 972-1900.


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	Contact Us: jody.slagle@ci.austin.tx.us or (512) 972-1950.
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