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General Information
Trade Name  
Date  
Address  
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Business Phone  
Fax No  
Is this the Branch Office: Yes No

Legal Name of Parent Company?
Years in Business:
Ever filed bankruptcy: Yes No
Type of Business: Retail Services Wholesale Other
Legal Structure: Proprietorship Partnership Corporation Other

 
Principals or Officers
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    City, State & Zip  
    Home Phone  
Name  
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    Home Address  
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Name  
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References (Banking and Trade Suppliers excluding Utilities)
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Trade References
1. Name  
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    Account No.  
    Address  
    City, State & Zip  
    Phone No.  
    Fax No.  
2. Name  
    Contact  
    Account No.  
    Address  
    City, State & Zip  
    Phone No.  
    Fax No.  
3. Name  
    Contact  
    Account No.  
    Address  
    City, State & Zip  
    Phone No.  
    Fax No.  
 










 
           

Southwaste Services, Inc.
9575 Katy Freeway, Suite 130, Houston TX 77024
Toll-Free: (866) 413-9494 | Phone: (713) 413-9400 | Fax: (713) 413-4179



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