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Recycling Supplies Order Form

Use this form to order recycling supplies. New customers should complete our credit application before completing this form.

Recycling Supplies Order Form

DescriptionQuantityTypical Usage

4' Cardboard Box: Holds 60 T12 or 120 T8 lamps

8' Cardboard Box: Holds 30 T12 or 60 T8 lamps

4' Fiber Drum: Holds 150 T12, 275 T8, or large HID

42x42x42 Gaylord Box: Holds e-waste, lighting fixtures, or non-PCB ballast

55 Gallon Steel Drum: Holds batteries (requires liner) or ballast.

5 Gallon Plastic Drum: For ballast, batteries, or broken lamps.

Generator of Waste

Name: *

Address: *

City: *

State: *

Zip: *

Contact: *

Email: *

Phone: *

Fax:

Submitter's Name: *

Customer Info

Customer: *

Same as Generator

Not Same

Specify whether customer information is the same as that of the waste generator listed above.

Name: *

Address: *

City: *

State: *

Zip: *

Contact: *

Phone: *

Fax:

Email: *