Certified Clean Green Program Application

Note: Prior to filling out this form, you will need to obtain an Express Exit Decal from a City of Phoenix Transfer Station. You will be required to enter your Express Exit Decal number in order to submit your Certified Clean Green Application.

For questions regarding this application or the Certified Clean Green program, contact Solid Waste Disposal at 602-495-3784.

Please wait while your form is submitted.

*denotes required field

Customer Information

* Business Name:
* Nombre de la Compania

* Contact Person Name:
* Nombre del Contacto

* Business Address:
* Direccion de la Compania

* City:
* Ciudad

* Zip Code:
* Zona Postal

* Email:
* Correo Electronico

* Phone Number:
* Numero de Telefono

Vehicle Information

List the Express Exit Decal Number of all company vehicles:
(up to 8 vehicles per form submission)

* Express Exit Decal Number
Vehicle #1:

Express Exit Decal Number
Vehicle #2:

Express Exit Decal Number
Vehicle #3:

Express Exit Decal Number
Vehicle #4:

Questionnaire

Would you like your company to be listed as a Certified Clean Green company on the City of Phoenix Green Business website?
Yes!
No, thanks!

What percentage of the green materials you will be delivering under this program originate from:

Residential Homes
(i.e. single-family homes, duplexes, four-plexes, condos, apartments)

Commercial Businesses
Resorts/Hotels, Streetscapes, etc.

By typing my full name below, I confirm that I received a copy of the Certified Clean Green Program Agreement and I understand that if terms of the agreement or any other City of Phoenix Disposal Facility regulations are violated this Certified Clean Green Program Agreement may be revoked.

Name of Owner, Partner, or Corporate Officer
Firma del Propietario, Socio, o Functionario Corporativo

Certified Clean Green Program Application

Customer Information

Vehicle Information

Questionnaire

Review

Thank you for your submission!

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