Dade: (305) 759-5002
Fax: (305) 759-6103
Toll Free: (800) 276-5144
This form can be used when you do not have an established account.
NOTE: This form should not be used after hours. Please call direct at the phone numbers listed above.
Note: If you do not wish to send credit card information over the internet, you can leave this part blank, go back to the Online Services page after submitting this form, and click on "Credit Card Authorization". You can then print the authorization form, fill it and fax it to us for immediate processing of your order.
Serving South Florida for Over a Decade
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