Registration Form for Cell Phone Recycling

Registration Form

Organization Name


Make Payment(s) To (if different from the organization)


Contact Name & Title


Mailing Address - No PO Boxes Please


City	State	ZIP Code


Telephone	Other Phone


Email - Very Important!


Web site address

What is the Special Event or Fundraiser you are raising money for?

When do you plan on starting program?

What's the best time of day to contact you?

How did you hear about ECO-CELL?

*If your organization is planning on collecting for the long-term and you would like to be added to our state locator map of collection sites, please check* here.**	Yes No

To return the completed form to ECO-CELL, press Submit.

We will be contacting you shortly and look forward to working with you.
Thank you for your interest in ECO-CELL. For more information, please contact us.