Quebec-Collection facility registration form

Drop-off location registration form
Company Name*
Company name
Contact Information*

First NameLast Name
Title*
Title
Email*
example@example.com
Phone Number*

Area CodePhone Number
Company Legal/Mailing Address*

Street Address

CityProvince

Postal Code
Collection Facility Physical Address (if different)

Street Address

CityProvince

Postal Code
GST #*
Indicate your GST number
QST #*
Indicate your QST number
*Information necessary in order to emit sign up bonus payment.
Business hours*
Where have you heard about the SOGHU ?*
Television, website, magazines, newsletters, etc.
I, {contactInformation}, {title} , declare to be duly authorized to act herein and certify that our company, association or municipality {companyName} acts in accordance with applicable laws and regulations.
Signature*

I confirm this signature.
Date*

DayMonthYear
Should be Empty:

Drop-off location registration form