Pull the Plug
Recycling Form
Today’s Date - 06/05/20

Eligible empty appliance(s) must be in a readily accessible location. Please do NOT put the appliance out by the road.

Refrigerator and/or freezer doors must be securely closed when appliance recycler arrives for collection.

Is this appliance ready to be picked up?
If yes, please proceed and complete rest of form.
If not, please do not continue until you are ready
for the appliance pick-up to be scheduled.

Co-op Information
Recycle Month/Year
G & T
Person completing the form
First Name
Last Name
Co-op member information
First Name
Last Name
Mailing Address
Daytime Phone Number
(phone number in xxx-xxx-xxxx format)
Alternative (e.g. Cell Phone) Number
(phone number in xxx-xxx-xxxx format)
REC account number
Email address
Pickup location
Check to copy address if pickup is the same as above.
Location of appliance(where in house)
Nearest cross street
Requesting recycling of the following appliances
Window A/C  
Have you participated in a recycling program in the past year?


E.g. Any non-program appliances to pickup (at member’s expense, $20 each(outside) or $50 each(inside), such as computer, TV, water heater, stove, dishwasher, microwave, washer, dryer)
E.g. Alternate phone number
E.g. best time to call during business hours


Appliance recycler is CLEAResult.
4651 8th Avenue
Marion, IA 52302
Office - 319.369.0463
Cell: 319.721.9599