| Co-op Information |
| Co-op/Muni |
|
| Person completing the form |
| First Name |
|
| Last Name |
|
| Co-op member information |
| First Name |
|
| Last Name |
|
| Mailing Address |
|
| City/State/Zip |
|
Daytime Phone Number
(phone number in xxx-xxx-xxxx format) |
|
Alternative (e.g. Cell Phone) Number
(phone number in xxx-xxx-xxxx format)
If there is a second phone number at which you can be reached, please be sure to list here. |
|
| REC account number (if known) |
|
| Email address |
|
| Pickup location |
| Check to copy address if pickup is the same as above. |
|
| Address |
|
| City/State/Zip |
|
|
|
Requesting recycling of the following appliances
The maximum number of appliances eligible for free pickup and recycling by the REC is 3. Additional items may be picked up during the same trip at the member’s own expense. |
Window A/C
(If more than one, indicate age of oldest unit.) |
|
Freezer
(If more than one, indicate age of oldest unit.) |
|
Refrigerator
(If more than one, indicate age of oldest unit.) |
|
| |
| Have you participated in a recycling program offered by your electric cooperative in the past year? |
|
|
|
Comments
E.g. Any non-program appliances to pickup (at member’s expense, $25 each, 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 |
|
Appliances must be in working condition. All applications must be approved by the cooperative. After approval, member will receive contact from REC’s contractor, Environmental Services of Iowa, to make arrangements for collection date and time. |
|