Your Name*

Company Name (If Applicable)

Zip*

Phone*

Currently Recycling*

—Please choose an option—YesNo

If No, how do you currently dispose of paper and plastics?

—Please choose an option—CompactorDumpsterRoll-off BoxOther

Other:

If Yes, what service are you currently utilizing?

—Please choose an option—BalerCompactorRecycling DumpsterOther

Other:

# of bins and/or bales:

Frequency of pick ups:*

—Please choose an option—Less than once a month1 x a month1 x a weekMore than once a week

% of recyclables in trash:* (Rough estimate)

—Please choose an option—75%50%25%Less than 10%

Your Email

*=required field