Switch Out | Registration Form

Name of Facility:
First Name:
Last Name:
Email Address:
Phone Number:
Fax Number:
Facility Address:
City:
Province:
Postal Code:
Mailing Address Same As Above

Mailing Address:
City:
Province:
Postal Code:

Number of cars processed per year:

Do you already have a Switch Out collection container? Yes
No

Are you a member of any of the following? If so, please specify: Canadian Association of Recycling Industries (CARI)
Automotive Recyclers of Canada (ARC) - includes all provincial recycling associations
ARC and CARI
Other recycling associations or organizations (please specify)
None

How did you hear about Switch Out? CARI
Recycling Association
Government
Summerhill
Other

Comments, questions, site feedback:

Please send me updates on Summerhill Impact's programs.

The information collected in this registration form will not be distributed for purposes other than for the national Switch Out program. Summerhill Impact may disclose this information to partners, supporters and funders of the Switch Out program, but will not sell or distribute the information to any third parties not directly involved in the Switch Out program.