Date *
WARE Representative Name: *
WARE Rep E-Mail: *
Account Holder Name: *
Account Number *
Account Phone: *
Contact 1 Name: *
Contact 1 E-Mail: *
Contact 1 Phone: *
Contact 2 Name:
Contact 2 E-Mail:
Contact 2 Phone:
Account Street Address: *
City: *SelectLos AngelesIrvineNewport BeachCosta Mesa
Zip Code: *
Account Billing Address if Different
City
Zip Code:
Business Type: *SelectHospitalityRetailServicesManufacturingVehicularGroundsFood ServicesConstruction & DemolitionOfficesShipping & Receiving
Number of Employees *
Multiple Locations *SelectYesNo
Name All Businesses That Share These Bins? *
Current Hauler Name: *
Current Hauler Contact Name: *
Current Hauler Contact Phone: *
Who is Recycler Company
Recycler Contact:
Recycler Phone::
Black Trash Bin Type *Select95Gal1 YD1.5 YD2.0 YD3.0YD4YD5YD6YD
Black Bin QTY: *0123456789
BLack Collection Freq *0x1x2x3x4x5x6x7x8x9x
Monday Collection:
Tuesday Collection:
Wednesday Collection:
Thursday Collection:
Friday Collection:
Saturday Collection:
Sunday Collection:
Black Bin Contents: *SelectWetDryBoth
Black Content Fill Level: *Empty1/4 Full1/2 Full3/4 FullFullOverflow
Black Content Recyclable: *SelectLess Than 25%25%-50%50%-75%100%
Paper:
OCC
Metals
Plastics
Wood
Carpet
Organics
Cans
Bottles
Glass
Concrete
Dirt / Sand
Blue Recycle Bin Type *Select95 Gal1 YD1.5 YD2.0 YD3.0YD4YD5YD6YD
Blue Bin QTY: *0123456789
Blue Collection Freq *0x1x2x3x4x5x6x7x8x9x
Monday Collection
Tuesday Collection
Wednesday Collection
Thursday Collection
Friday Collection
Saturday Collection
Sunday Collection
Blue Bin Contents: *SelectWetDryBoth
Blue Bin Fill Level: *Empy1/4 Full1/2 Full3/4 FullFullOverflow
Blue Bin Contamination: *SelectLess Than 25%25%-50%50%-75%100%
Paper Blue
Green Organic Bin Type *Select95 Gal1 YD1.5 YD2.0 YD3.0YD4YD5YD6YD
Green Bin QTY: *0123456789
Green Collection Freq *0x1x2x3x4x5x6x7x8x9x
Green Bin Contents: *SelectWetDryBoth
Green Bin Fill Level: *Empty1/4 Full1/2 Full3/4 FullFullOverflow
Green Bin Contamination: *SelectLess Than 25%25%-50%50%-75%100%
Roll-Off Type *Select10YD15YD20YD25YD30YD40YD
Roll-Off QTY: *0123456789
Roll-Off Frequency *SelectNoneDailyWeeklyBi-WeeklyMonthlyOn-Call
Compactor Container Type *SelectNone10YD15YD20YD25YD30YD40YD
Compactor Container QTY: *Select0123456789
Compactor Collection Freq *SelectNoneDailyWeeklyBi-WeeklyMonthlyOn-Call
Reduce Programs *
Re-Use Programs *
Confidential Paper ? *SelectYesNo
CPD Service Company
CPD Service Contact
CPD Service Phone
Janitor Service ? *SelectYesNo
Janitor Co
Janitor Co Contact
Janitor Co Phone
Is There a Baler? *SelectYesNo
Self Haul? *SelectYesNo
EPP Policy in PLace? *SelectYesNo
Shared Bin? *SelectYesNo
How Many Co’s Share? *
Accessible? *
Valet Service? *SelectYesNo
Distance? *SelectLess than 50 ft50 ft - 100 ft100 ft - 150 ft100 ft - 150 ft150 ft - 200 ft200 ft - 250 ftOther see notes
Gates? *SelectYesNo
Garage *SelectYesNo
Locked Bins? *SelectYesNo
Notes
