Quebec-Collection facility registration form

For SOGHU usage only

Invoice: ___________________________________

GL # ________________ Date: _______________

QST (9.975%) _______________
GST (5%) __________________

Sub-total: __________________
Total: _____________________

Prepared by ________________________________

Signature __________________________________

Company Name*

Company name

Contact Information*

First NameLast Name

Title*

Title

Email*

example@example.com

Phone Number*

Area CodePhone Number

Company Address*

Street Address

CityProvince

Postal Code

Collection Facility Address*

Street Address

CityProvince

Postal Code

GST #*

Indicate your GST number

QST #*

Indicate your QST number

Opening hours*

	Opening	Closing
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Collector's Name*

Skip this question if you have not yet determined who is/will be your collector

*If you haven't found your Collector yet, choose one in our collector's list serving your area.

Where have you heard about the SOGHU ?*

Television, website, magazines, newsletters, etc.

This agreement authorizes SOGHU to register your company with SOGHU as a Collection Facility for used oil, used oil filters, used containers of oil and antifreeze (including used containers of 50 litres or less, break cleaner and lubricant aerosol containers) for the general public.

Your information will be posted on our website or given verbally to those who call in. You agree to function as a Collection Facility for a minimum of 1 year and offer the drop-off service free of charge to the public.

You are responsible for contacting SOGHU to report any changes that occur to the information posted on the website. SOGHU will forward you a one-time bonus of $ 100.00 plus taxes after 3 months of operation as a thank-you for assisting the SOGHU program. Your company will continue to be displayed on our website as an active Collection Facility until such time as you request to be removed.

I, {contactInformation}, {title} , declare to be duly authorized to act herein and certify that our company, association or municipality {companyName} acts in accordance with applicable laws and regulations.

Signature*

I confirm this signature.

Date*

DayMonthYear

SOGHU - Collection Facility Registration Form