3CYCLE

Email address*

Name*

Company:*

Phone Number:*

Type of Industry: (please check all that apply)*

Other*

Type of services you are interested in receiving: (please check all that apply)*

Other*

Process Information

In the following section we will attempt to capture information allowing us to assess the current process.

Is there currently a provider for the type(s) of service(s) requested?*

Yes

No

List the type(s) of material to be processed? (please check all that apply)*

Other*

Are special certifications required for the service(s)? (please check all that apply)*

Other*

If there are other factors or considerations for the assessment not covered in the previous questions, please provide a description below.