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Organization Type:	*Due to the high cost of shipping, we are only able to recycle with in the continental U.S.
Organization Name:
Make Check Out To:	(If different from Organization Name)
Contact/Check Attention To:
Mailing Address:
City:
State:
Zip Code:

Shipping Address:	Same as Mailing Address
Street Address:
City:
State:
Zip Code:
Phone:
Contact Phone:
Fax:
Email Address:
Where did you hear about us?	Please Specify
Questions or Comments?
Shipping / Promotional Items
	Check here to request a Starter Kit, or fill out individual item quantities below. A Starter Kit consists of the following... 2 Prepaid Shipping Labels (you will receive 2 more with each check we send you.) 1 Inkjet Collection Box 1 Flyer 1 Wall Poster Check here to request a Starter Kit, or fill out individual item quantities below. A Starter Kit consists of the following... 2 Prepaid Shipping Labels (you will receive 2 more with each check we send you.) 1 Inkjet Collection Box 1 Flyer 1 Wall Poster
	Check here to receive 2 Prepaid Shipping Labels (you will receive 2 more with each check we send you.)
	Check here to receive 1 Inkjet Collection Box
	# of Flyers
	# Inkjet/Cell Phone Collection Boxes
	Wall Poster
	Shipping Boxes
	Pre-paid Shipping Labels

You may request additional supplies once your first qualified shipment is processed on the database. When ordering supplies, please log in using your user name and password instead of using the registration page.
*If you don't receive email confirmation of your registration within 48 hours, please call: 1-800-706-9941

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