HomeMy WebLinkAboutVVS Senior Citizen Discount FormValley Vista Services, Inc.
17445 E. Railroad Street
City of Industry, CA 91748
Office: (626) 855-5501
Fax: (626) 581-3297
Email: vvsdiscount@myvvs.com
To be eligible for the senior discount, you must be 60 years of age or older, listed as the account
holder, and reside at the service address.
APPLICANT INFORMATION
Name (Applicant must be Head of Household):
Address:
City: State: Zip Code:
DOB (mm/dd/yy): Age of Applicant: Current Phone #:
Driver’s License/Identification Card #: Email:
The undersign declares that the following information is true. If any portion of this information
is not valid, the undersigned will be required to remit to Valley Vista Services the full rate for
residential waste collection services.
Signature of Applicant: __________________________ Date: __________________________
IMPORTANT INFORMATION
•If mailing the application, please include a COPY of your valid California Driver’s License or
Identification Card.
•If submitting the application in person, a valid California Driver’s License or Identification
Card must be presented for processing.
NOTE: Please ensure the address on your California ID/DL matches the service address.
For Office Use Only
Account #: __________________________
Application: Approved Denied
Processed By: __________________________ Date: __________________________
CITY OF DIAMOND BAR
SENIOR CITIZEN DISCOUNT
APPLICATION
(60 Years & Older)