Pay Now Pay Online Use the form here to provide your secure and easy online payment. Pay Now Online Payment First Name*Last Name*Email* CompanyPhone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment InformationCustomer or Account Number*Invoice or Service Address*Enter the invoice number(s) or the address of waste service. You may enter more than one.Payment Amount* Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Terms and ConditionsNational Site Materials Company, Inc. (Contractor) agrees to supply and sell materials to the Customer, on the terms and conditions set forth in this agreement. SUSPENSION AND TERMINATION FOR CAUSE. If, during the term of this Agreement, either party shall be in breach of or default in any provision of this Agreement, the other party may suspend or terminate its performance hereunder until such delinquency or default has been corrected, provided, however, that no termination shall be effective unless and until the complaining party has given written notice of default to the other party and the other party has failed to cure such Default within at least ten (10) days thereafter. In the event any such Default remains uncured for a period of ten (10) days, the complaining party may terminate this Agreement by giving the other party written notice of such termination; such termination to become effective upon receipt of such notice. TERM. This agreement is a legally binding contract and shall extend for an initial term of three (3) years from the date hereof, and shall be automatically renewed for successive 3 year terms (the renewal term) thereafter, unless either party shall give written notice of termination (Certified Mail) to the other at least sixty (60) days prior to the expiration of the initial term, or any renewal term. In the event the Customer shall discontinue this Service Agreement other than as provided above, it is agreed and contracted that said Customer shall pay to Contractor as liquidated damages a sum equal to six months charge to be determined on the basis of the average of the latest six months invoices during the existence of this Service Agreement, or if Customer has not been serviced for six months, Customer’s most recent monthly charge multiplied by six. This agreement includes any recyclable material, non schedule or on call service with exclusive rights to contractor. Contractor agrees that if Customer no longer requires any collection, disposal, or recycling for its materials, through discontinuance of its business or relocation outside the area in which Contractor provides collection service, Customer may terminate this agreement upon written notice (Certified Mail) at least sixty (60) days prior to the intended termination date, but only upon payment of all amounts then due Contractor. DEFINITION OF EQUIPMENT. The word “equipment” as used in these Terms and Conditions shall mean all containers used for storage and transportation of material including trucks, delivery vehicles, tanks and such other on-site devices as may be specified on the face of this agreement. CUSTOMER’S DUTIES AND LIABILITIES. The Customer understands and agrees that it is the Customer's responsibility to provide an appropriate and safe delivery and unloading site. The Contractor, its employees, subcontractors and agents are not liable to Customer for any claims, damages, injuries, or economic loss, to any person or property, caused by or related to an inadequate delivery or unloading site. Customer agrees to be financially responsible for any and all fees, expenses or damages caused by an inadequate delivery or unloading site including, but not limited to, damage to delivery vehicle and apparatus. On delivery day, the Contractor’s vehicle shall have clear access to the designated delivery area. If the area is blocked to prohibit delivery, Customer will be notified and one additional attempt for delivery shall be made by Contractor’s vehicle. Any additional delivery attempts will be classified an “extra delivery” and so duly charged. The Contractor is not liable for any damages incurred during delivery including but not limited to lawns, driveways, curbs, trees, utilities, septic systems or irrigation systems or structures. The Customer expressly releases the Contractor from all claims, demands, injuries, damages, and economic loss related to the delivery of the materials. Any equipment provided by the Contractor is done so for the Contractor’s convenience in providing the service called for by this Agreement. All equipment furnished by the Contractor for use by the Customer which the Customer has not purchased, shall remain the property of the Contractor and the Customer shall have no right, title or interest in equipment. Customer shall be responsible for the cleanliness and safekeeping of the equipment. Customer shall be liable to Contractor for loss or damage in excess of reasonable wear and tear. All equipment is to be returned as it was received, any equipment that needs to be cleaned or maintained will be invoiced accordingly. INDEMNITY. The obligations of the parties under this section shall survive the expiration or termination of this agreement. Customer agrees to defend, hold harmless and indemnify Contractor against all claims, lawsuits, judgements, demands and any other liability of injury to persons or damage to property or the environment connected with the use of the equipment by the Customer or breach of any warranty by the Customer. RATE ADJUSTMENT. Because delivery and fuel costs constitute a significant portion of the cost of National Site Materials services provided hereunder, Customer agrees that National Site Materials may increase the rates hereunder proportionately to adjust for any increase in such costs or any increases in transportation cost due to changes in location of the disposal facility. Customer agrees that the Contractor may increase rates from time to time to adjust for increases in the cost of doing business. Furthermore, customer agrees the Contractor may proportionately pass through to Customer increases in cost as a result of weights being higher than those estimated. Rates may also be increased to reflect increase in taxes, fees or other governmental charges assessed against or passed through to the Contractor (other than income or real property taxes), the Contractor may only increase rates for reasons other than those set forth above with the consent of the Customer. Such consent may be evidenced verbally, in writing or by the actions and practices of parties. CHARGES AND PAYMENTS. Customer shall pay the Contractor for materials and delivery service provided by the Contractor (including all charges for equipment maintenance). Payments shall be made by Customer within ten (10) days after receipt of an invoice from the Contractor. In the event that any payment is not made when due, Contractor at its sole option may at any time terminate the Agreement on notice to the Customer and recover any equipment on the premises of the Customer. Any non-payment by Customer of charges due hereunder shall, at the election of Contractor, be deemed to be a termination by the customer pursuant to and subject to the terms above. Contractor may impose, and Customer agrees to pay, a late fee for all past due payments. Due to the nature of the product, color, sizing and characteristics may vary and cannot be guaranteed. All materials are non returnable and non refundable. If material is refused at delivery and/or returned to its point of origin the contractor will collect the haul rate plus the current fuel surcharge and any additional fees as applicable. CHANGES. Changes in the schedule of charges, material to be delivered, delivery date and location and type of equipment may be agreed to orally or in writing, by the parties. Consent to oral changes shall be evidenced by the actions and practices of the parties. CANCELLATION. Any and all orders that are placed with in a Forty-Eight (48) hour window prior to delivery date are non-refundable. All orders that are placed prior to the Forty-Eight (48) hour window can be canceled by emailing email@example.com Forty-Eight (48) hour prior to the confirmed delivery date. Any and all orders that require a binder for orders over one thousand dollars ($1000) are nonrefundable if not canceled within one week (120) Hours prior form the date of the scheduled delivery, the order can be cancelled by emailing firstname.lastname@example.org. DRIVEWAYS AND PARKING AREAS. Customer warrants that any right of way provided by Customer from Customer’s equipment location to the most convenient public way is sufficient to bear the weight of all the contractor’s equipment and vehicles reasonably required to perform the service herein contracted. Contractor shall not be responsible for damage to any private pavement or accompanying sub-surface of any route reasonably necessary to perform the services herein contracted. INVALIDITY. The invalidity or unenforceability or any one or more of the particular provisions of this Agreement, none of which are known to the parties, shall not affect the enforceability of the other provisions herein. CHOICE OF LAW AND VENUE. This Agreement is governed exclusively by Florida law including Florida choice of law principles applicable to contracts to be wholly performed in the State of Florida. Should any dispute arise from any performance obligations under this Agreement, the parties expressly agree that the dispute will be adjudicated exclusively in the Jacksonville Superior Court or the United States District Court for the Duval County, Florida, as applicable. ATTORNEY’S FEES AND COSTS. If any action at law or in equity is necessary to enforce or interpret the terms of this Agreement, the prevailing party shall be entitled to its actual attorney’s fees and costs. ASSIGNMENT AND BENEFIT. This Agreement may not be assigned by the Purchaser without the express written consent of National Site Materials or any of its affiliated companies. MISCELLANEOUS. If any conflict or differences exist in this agreement between terms which are printed and those which are typed or written, the typed or written language shall govern. ENTIRE AGREEMENT. The terms and conditions herein constitute the entire and only agreement between the parties hereto and supersedes all previous communications, representations, understandings and agreements, whether written or oral, between the parties. No amendment or modification of the terms and conditions contained herein shall be binding unless agreed upon in writing and signed by both parties. NOTICES. All notices, requests, demands, and other communications hereunder shall be in writing and shall be deemed given at the time such communication is sent by registered or certified mail or recognized national overnight courier service, or delivered personally, to the following addresses (or at such other address for a party as shall be specified by like notice): National Site Materials Company, Inc. 16150 N. Main Street Jacksonville, FL 32218 email@example.com 888-237-2746I Agree* I agree to the Terms and Conditions Total $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.