WIT Enrollment Form

This form is required for new members to use our services.
When submitting this form, you understand and are in agreement with the following:

Industry Training, LLC, dba Waste Industry Training herein called "WIT" and the WIT Distributors, WIT Industry Partners, WIT Sponsors, WIT Advisors, WIT Third Party Providers, and WIT Authors, herein called "WIT Affiliates", assumes each customer has reviewed the courses to determine if the courses meet their company rules, regulations, and procedures as well as any regulatory agency requirements for training employees. Materials, Information, and Training Courses within the WIT web site are for informational purposes only. They are not legal advice and should not be used as such.

These courses are intended for educational purposes only. WIT and WIT Affiliates views have not been approved by any government or regulatory agency, organization, or business. The publication is distributed with the understanding that the authors are not engaged in rendering legal or other professional advice, and that the information contained herein should not be regarded (or relied upon) as a substitute for professional consultation. The use of information contained herein constitutes an agreement to hold WIT and WIT Affiliates harmless for liability, damage, professional fees, or expense incurred as a result of reference to or reliance upon the information provided. Mention of a proprietary product or service does not constitute an endorsement by the authors or their employers.

WIT and WIT Affiliates assumes no liability for any incidental, consequential or other liability from the use of this information. All risks and damages, incidental or otherwise, arising from use or misuse of the information contained herein are entirely the responsibility of the user. Although careful precaution has been taken in the preparation of this material, we assume no responsibility for errors of omissions.

An enrollee will have 30 days from the date of enrollment to complete the training with a 15 day grace period. If training is not completed within 45 days, the employee after the 45th day would requre to be re-enrolled with another payment made to continue the training.
ACKNOWLEDGEMENT*

I have read, understand, and agree with the terms, conditions, and disclaimers as noted above.I do not agree with the terms conditions, and disclaimers as noted above.
Your Name*
Date*

MonthDayYear
Date
NOTE: Please have your Credit Card information ready. No enrollments will be made until payment is received.

REGISTRATION FORM
COMPANY INFORMATION
Company/Organization*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Main Number*

Area CodePhone Number
Is the Mailing address the same as above?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
HOW DID YOU HEAR ABOUT US?
Method:*

direct mailonline adgoogle searchbing searchprint adtwitterfacebookinstagramreferralSWANANWRANational Interstate InsuranceOther
PLEASE TELL US ABOUT YOUR COMPANY (These are Company Totals)
No. of Locations*
No. of Maint. Techs*
No. of Drivers*
No. of Helpers*
No. of Office Staff
CONTACT INFORMATION FOR MAIN LOCATION

(for Reporting and Enrolling)
MAIN CONTACT (Owner, General Manager, Director, etc.)
Main Contact Name (1)*
General Title (1)*
E-mail (1)*
Office Number (1)

Area CodePhone Number
Mobile Number (1)

Area CodePhone Number
SECOND CONTACT (Manager/Supervisor)
Contact Name (2)*
General Title (2)*
Email (2)*
Office Number (2)

Area CodePhone Number
Mobile Number (2)

Area CodePhone Number
Add Another (2)?*

YesNo
THIRD CONTACT (Manager/Supervisor)
Contact Name Name (3)*
General Position (3)*
Email (3)*
Office Number (3)

Area CodePhone Number
Mobile Number (3)

Area CodePhone Number
Add Another (3)?*

YesNo
FOURTH CONTACT (Manager/Supervisor)
Contact Name (4)*
Genral Position (4)*
Email (4)*
Office Phone (4)

Area CodePhone Number
Mobile Phone (4)

Area CodePhone Number
We allow one Manager for the company and a Supervisor for every 25 trucks. There is an additional charge for Supervisors beyond what is stated.
SECOND LOCATION

(for Reporting and Enrolling)
LOCATION INFORMATION
Location Name (2a)*
Physical Address (2a)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Location Phone (2a)*

Area CodePhone Number
CONTACT FOR SECOND LOCATION
Contact Name (2a)*
General Title (2a)*
Email (2a)*
Mobile Phone (2a)

Area CodePhone Number
PLEASE TELL US ABOUT THIS LOCATION - These are Location Totals (2a)
No. of Drivers*
No. of Helpers*
No. of Maint. Techs*
No. of Office Staff
THIRD LOCATION

(for Reporting and Enrolling)
LOCATION INFORMATION
Location Name (3a)*
Physical Address (3a)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Location Phone (3a)*

Area CodePhone Number
CONTACT FOR THIRD LOCATION
Location Contact (3a)*
General Title (3a)*
Email (3a)*
Mobile Phone (3a)

Area CodePhone Number
PLEASE TELL US ABOUT THIS LOCATION - These are Location Totals (3a)
No. of Drivers*
No. of Helpers*
No. of Maint. Techs*
No. of Office Staff
FORTH LOCATION

(for Reporting and Enrolling)
LOCATION INFORMATION
Location Name (4a)*
Physical Address (4a)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Location Phone (4a)*

Area CodePhone Number
CONTACT FOR FORTH LOCATION
Location Contact (4a)*
General Title (4a)*
Email (4a)*
Mobile Phone (4a)

Area CodePhone Number
PLEASE TELL US ABOUT THIS LOCATION - These are Location Totals (4a)
No. of Drivers*
No. of Helpers*
No. of Maint. Techs*
No. of Office Staff
If you have more than four (4) locations,

please email us each location and contact information.

Send to:

Admin@WasteIndustryTraining.com

To continue with setting up your company, you must agree to our terms. Please click the back button to review our terms and continue with the setup process.
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