First Name

Last Name

Company

Email

Phone

Do You Have a Recycling Program? YesNo

Describe This Program?

Are You Currently A Paper Retriever Program Customer? YesNo

Where Do You Get Majority Of Your Paper?

Why Do You Want To Institute The Paper Retriever Program

Site Address Hosting Location Address

Site City Hosting Location City

Site Zip Hosting Location Zip

Current Waste Hauler Who Hauls Your Waste?

Monthly Trash Bill Numbers Only

Waste Hauler Contract Expiration Date

Comments