Application For Curbside Registration Form
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Application for Curbside Registration
Mail to: CalRecycle • Division of Recycling • Curbside Section
801 K Street • MS 15-59 • Sacramento, CA 95814-3533
Questions? Call: (916) 323-3008
Office Use Only
Instructions
• Print in Ink or Type.
App. # _____________________________________
❏
New
• Submit a Separate Form for Each Curbside
Curbside ID# _______________________________
❏
Renewal
Program for Different Agencies
• Indicate N/A for items not Applicable.
Expiration __________________________________________________
OPERATOR INFORMATION
1)
Contact Person _________________________
________________________________
_________________________________________
_______________________
First
Middle
Last
Title
1
Organiza
tion Name ________________________________
__________________________________________
____________________________________________
Parent Company, If applicable
Fictitious Business Name, If applicable
Business Address
___________________________________
_________________________
___________________________
___________
_______________
Address
City
County
State
Zip Code
Mailing Address ____________________________________
_________________________
___________________________
___________
________________
Address
City
County
State
Zip Code
( _____ ) __________________________________________ (
)
Telephone Number
_______
________________________________________________________________
Fax
Type Of Organization
2)
(Check one box)
3
❏
a.
Individual:
❏
❏
❏
b.
Partnership:
General or
Limited Submit copy of current partnership agreement.
❏
c.
N
umber as filed with Secretary of State ____________________________________________________________________
Corporation:
Submit articles of incorporation and list of current corporate officers.
Profit
or
Nonprofit (Select one)
Domestic or
Foreign (Select one)
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process
❏
d.
Limited Liability Company:
Submit articles of organization, statement of information and operating agreement.
Foreign (Select one)
Domestic or
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process __________________________________________________________________________________________
❏
e.
Husband and Wife Co-Ownership:
Name of Spouse _____________________________________________________________________________________
❏
f.
Local Government Agency:
___
City
__
__ County
_
___
City & County
_
___
Other
Submit governing board resolution authorizing this application.
❏
g.
Federal Agency:
Military Installation
National Park
Other
Federal Property
Submit governing board resolution authorizing this application.
❏
h.
Joint Power of Authority (JPA)
Submit governing board resolution authorizing this application.
❏
i.
Other: Specify ____________________________________________________________________________________________________
3) Submit a copy of the fictitious business name statement, if applicable
4)
Federal ID # (Employer ID#) _______________________________________________________________________________________________
Corporations, partnerships and other organizations with paid employees must provide a Federal ID#.
Printed on recycled paper
DOR 50 9/10
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