2. Name of Company*
4. Street Address*
6. City*
7. State*
8. Zip Code*
10. Billing Address (if different than above street address)
12. City
13. State
14. Zip Code
16. Name of Owner*
17. Owner Address
19. City
20. State
21. Zip Code
23. Owner Phone #*
24. Office Phone Number
26. Contact Person*
28. Contact Phone #*
29. Cell Phone #
31. Fax Number
32. email address:

34. Guidelines

    • Do Not pay individual landfill tickets. Please pay from the City of Bismarck monthly statement / invoice(s) that is mailed.
    • $10 set-up fee will be billed on your first invoice.
    • $5 Minimum Monthly Charge: Landfill charge accounts will be billed a minimum monthly fee of $5 if total charges are less than $5 during the billing cycle. No monthly bill will be generated for accounts with no charges during billing cycle.
    • Billing Cycle: 20th of the month to the 19th of the following month.

36. The Public Works Department will contact you when the account is active.
Leave This Blank:


38. Submit

* indicates a required field