Portable Restroom Order Form - True Loo Waste Services

Project Name / Job Site(Required)

Requested Delivery Date(Required)

Rental Type(Required)

Construction / Long-Term

Event / Short-Term

Delivery Address(Required)

Street Address City State ZIP Code

How many times a week should the units be serviced?

Delivery Instructions

Please tell us where you'd like the units placed and include gate codes, access instructions, or anything else our driver should know.

Equipment Needed

Enter the quantity needed for each item. Leave any items you do not need blank.

Portable Toilet Units

Enter the quantity needed for each restroom type.

Standard Units

ADA Units

High Rise Units

Half Johns

Hand Washing & Tanks

Hand Wash Stations

Fresh Water Tanks

Wastewater Tanks

Special Event Equipment

Special Event Units

Additional Equipment Requests

Need something not listed? Tell us here and our team will be happy to help.

Contact & Billing Information

Please provide your contact information so we can confirm your order and coordinate delivery.

Contact Name

First Last

Company Name

Mobile Phone

Office Phone (optional)

Email Address

Preferred Contact Method

Phone

Email

Either

Purchase Order Number (optional)

Billing Address

Street Address Address Line 2 City State ZIP Code

Payment Authorization

Please provide your payment information below. Your card will not be charged until a True-Loo representative has reviewed your rental request with you, confirmed equipment availability, finalized pricing, and received your approval to proceed.

Cardholder Name(Required)

Credit Card Number(Required)

Expiration Date(Required)

MM /YY

CVV(Required)

Billing Zip Code

Agreement Checkbox(Required)

I authorize True-Loo to charge the payment method provided after I have approved the final rental details, pricing, and applicable charges.