New Customer Form

Please provide the following contact information:

Contact Name
Company Name
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
FAX
E-mail	Your address will only be used to contact you about setting up service.

What kind of materials you are interested in recycling?

White Paper
Colored Paper
Mixed Paper
File Stock
Print Shop Waste
Magazines
Newspaper
Card Board
Confidential Document Shredding
Plastic Bottles
Aluminum Cans

Is there a badge required to enter the facility?

Yes No

Would you like a regularly scheduled pickup?

No, I will send a request for a pickup
Every Two Weeks
Every Three Weeks
Monthly

Additional Comments or Questions