Electronic Equipment Reclamation Project – Commercial Form
Retail Store Name__________________________
Retail Store Address_______________________
 
 
Store Proprietor/Owner______________
Contact Telephones____________________
Contact Email_________________________
Best Time to Contact_______________________
Willing to donate:  
Squeeky Clean Member Information
Member Name__________________________
Member User ID____________________________
Member Email_________________________
Member Telephone_____________________
Return to: www.squeekyclean.org, Squeeky Clean, LLC, P.O. Box 32, Hesperus, CO 81326