Certified Remanufactured Printer Cartridge Program

Certified Remanufactured Printer Cartridge Program

Application
Confidential

The information you provide in this application will remain confidential and will only be viewed by Executive Director and designated application processor of the CRPC. The CRPC shall hold and maintain the Confidential Information in strictest confidence for the sole and exclusive benefit of applicant. The CRPC shall carefully restrict access to Confidential Information to employees, contractors and third parties as is reasonably required and shall require those persons to sign nondisclosure restrictions.
Application?*

New application to become a "Certified Remanufacturer"Renewing application
Contact Name

First NameLast Name
Title*
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Business
E-mail
example@example.com
Company Website
Http://www.
Business Tax I.D.
Questionaire
Do you remanufacture ink cartridges?*

YesNo
Do you remanufacture toner cartridges?*

YesNo
Do you manufacture new built compatible ink cartridges?*

YesNo
Do you manufacture new built compatible toner cartridges?*

YesNo
How many OEM printer cartridge cores do you collect annually? Next to 1. & 2. input the estimated total amounts. If you don't collect any OEM cores put 0
1.Input estimated total Inks* 2.Input estimated total Toner
How do you obtain empty OEM cores?*
Explain your collection service or program
Do you have invoices or payment receipts for acquiring OEM cores? Items may be needed as part of the verification process.*

YesNo
How many ink cartridges do you remanufacture and sell annually?*
Number
How many Toner cartridges do you remanufacture and sell annually?*
Number
How many Brands of ink cartridges do you remanufacture and sell?*
Number
How many Brands of Toner cartridges do you remanufacture and sell?*
Number
List all the different brand names you remanufacture cartridges for?*
Address where cartridges are collect and sorted

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Send three pictures of the empties collection department

Cancelof
Address where cartridges are remanufactured

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Send three pictures of the remanufacturing department

Cancelof
Fees

The CRPC has an application and certification fee. The fees depend on the size and age of your company.
*

I AGREE to an onsite or virtual walk through of company's facilities.
*

I AGREE to pay all required fees on time. I assure all the information provided above is true, any false information will lead to cancelation of application and forfeiture of application fee.
Signature

Clear
Should be Empty:

Certified Remanufactured Printer Cartridge Program

Confidential

Questionaire

Fees