Washington Utilities And Transportation Commission For The Year Ended December 31, 2007 Annual Report Template
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5CLASS “C”
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(Specialized Carriers)
SOLID WASTE COLLECTION COMPANIES
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ANNUAL REPORT
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**Not Confidential**
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Full name and address of Company
Correct name and address, if different than shown
WASHINGTON UTILITIES AND TRANSPORTATION COMMISSION
for the
YEAR ENDED DECEMBER 31, 2007
Inquiries concerning this Annual Report should be addressed to:
NAME:
TITLE: _______________________________
ADDRESS: ____________________________________________________________________________
CITY: __________________________________ STATE: _____________ ZIP: _____________________
TELEPHONE: _______________________ FAX: _________________ E-MAIL: ____________________
The company must notify the Commission, in writing, of any changes to the above information.
TYPE OF PAYMENT - DO NOT SEND CASH IN THE MAIL
For Commission Use Only
Credit Card Authorization#:_________________
___ Check ___ Money Order ___ AMEX ___ Visa ___ MasterCard
Expiration Date
Credit Card Number:
Month/Year
CERTIFICATION: I, the undersigned, under penalty for false statement, certify that the information is true, valid and correct, that I am authorized to
execute on behalf of the applicant, and that I agree to pay the above total amount according to card issuer agreement.
Name (Printed):_______________________________________________
Title:____________________________________
Signature:_____________________________________________________
Date:____________________________________
For Commission Use Only
Reception Number:_______________________ 001-111-02-68-227-11 ________________________ Ref. No. _________________
001-111-02-68-227-01____________________________
001-111-02-68-032-05:___________________________
Original to be mailed to the Washington Utilities and Transportation Commission, PO Box 47250, Olympia, WA 98504-7250
Web Site:
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