Empties to WINN Registration Form (Residential)

Sign me up for the convenient and free Empties to WINN Program.
* indicates required information

Name:

*

Address:

*

Neighbourhood:

City:

*

Province:

*

Postal Code:

*

Phone:

() *

Email:

*

How did you hear about the program?

If you were referred by someone, please fill in their information below.

Name
Phone	()
Email

If you were referred by a staff member, please enter their name below.

Name

Do you require a tax receipt at the end of the year?*

Yes No
*Note: Each full bag is worth $16 towards an accumulative tax receipt issued at the end of each year. Value is calculated based on 10¢ containers.

Once your registration form is received, you will be contacted with a drop-off date for your free collection container and bags.