New Submission

North Carolina General Statute 130A-309.142, "Registration of Facilities Recovering or Recycling Electronics Required" states that facilities that recover or recycle covered devices or other electronic devices diverted from the waste stream for transfer, treatment, or processing shall register annually with the Department on or before August 1st of each year.
Fiscal Year Registration:*field type single line
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FY: XX - XX formatting (Ex. FY: 22 - 23)
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Company Facility Information

Company Name:*field type single line
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Phone:*field type single line
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Company Website:*field type single line
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Email:*field type single line
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Street Address:*field type single line
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Address Line 2:field type single line
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City:*field type single line
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State:*field type single line
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Zip:*field type single line
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County:*field type single line
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Same as business information:field type checkbox
Same as business information:Yes
Address:field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
County:*field type single line
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Name:*field type single line
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Direct Phone:*field type single line
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Fax:field type single line
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Email:*field type single line
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Address:*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
County:*field type single line
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Same as legal owner information:field type checkbox
Same as legal owner information:Yes
Name:*field type single line
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Title:*field type single line
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Direct Phone:*field type single line
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Fax:field type single line
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Email:*field type single line
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List information for all locations where electronics are stored, recovered, or recycled.
×
- Location Name:*field type single line
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- Address:*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- County:*field type single line
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- Check all that apply to this location:*field type checkbox
  Check all that apply to this location:Leased PropertyR2 CertifiedeSteward CertifiedCRTs AcceptedNot Applicable
Click button below to Add Additional Location(s):Add

I certify that the information provided in this document is true, accurate, and complete to the best of my knowledge. Furthermore, the Company will comply with all applicable federal, state, and local laws.
Signature*field type signature
Date*field type date
Name:*field type single line
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Title:field type single line
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Direct Phone:*field type single line
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Email*field type email