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Organization Registration Form

In order to utilize and have access to the Eco Reporting database, an organization must provide the following information and agree to the terms, conditions, and licensing agreement. Only those consumable items returned utilizing the associated account codes on the prepaid return label will appear in this data reporting tool

If access is approved and established for an organization, it is the responsibility of the tool Administrator for that organization to manage all aspects of access, registration, profiles, regions, locations and sub-locations for their organization.

Organization Information:
* = required
Organization Type: *
Full Name: *
Address: *
City: *
State: *
Zip code: *
Eco Tool Administrator Information:
* = required
Last Name: *
First Name: *
Phone No: *
Email Addresss: *
(Email address must have an organization relationship, must match company
domain- third party addresses are not acceptable)
License Agreement: *
Please read terms of use before proceeding by clicking link. Once completed, check the box below to electronically sign and agree to ULA.
   [check to electronically sign ULA]  
Enter CAPTCHA: *  
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