Please provide the following information about your business or organization. We will be in contact with you to verify facts or ask questions about your services. Thank you.

Contact information
Contact person	*
Business name	*
Address	*
City	*
State	*	- - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip	*
Phone	*
E-mail
Web site
Hours
Year started
Services
Service type	*	Drop-off Pickup Both
Service frequency
Types of items accepted
Communities served
(must provide services in some, if not all, of these counties: MO - Cass, Clay, Jackson, Platte, Ray; KS - Johnson, Leavenworth, Miami, Wyandotte)
Extra pickups
Cost of services
Final destination for item(s) accepted
(be as specific as possible with end users and locations)
Tons diverted from landfill annually
Tons disposed of in landfill annually
Restrictions
Notes or comments
Type this code	*