Prospective New Grease Recycling Customer Form

Fields in bold are required
First Name:
Last Name:
Telephone:
Email address:
Best time to reach you:
Store Name:
Store Address:
Store Telephone:
Details
Is store open?	Yes No
If store isn't open, when is it scheduled to open?
Do you currently have service with another company?	Yes No
Do you currently have containers on site or in grease buckets?	Yes No
If you do have container, are they inside or outside?	Inside Outside
Comments: