Pull the Plug
Recycling Form
Today’s Date -

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
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)
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.
Location of appliance(where in house)
Nearest cross street
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.)
(If more than one, indicate age of oldest unit.)
(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?


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, CLEAResult, to make arrangements for collection date and time.