Oregon CVP Covered Entity Pickup Agreement

Thank you for your interest in mattress recycling. MRC’s Commercial Volume Program helps businesses and organizations participate in MRC’s Bye Bye Mattress program.

This form is provided by invitation only and is intended for businesses and organizations seeking to receive no-cost pickup, transportation and recycling of their units at a participating recycling facility.

Contact Joy Broussard at ORcvp@mrc-us.org or (707) 307-3052 with any questions.

Type of Business/Organization(Required)

1. Location Information

Name of Business/Organization Requesting Service(Required)

Name of Pickup Location

Pickup Street Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

2. Contact Information

Primary Contact Name(Required)

First Last

Primary Contact Title(Required)

Primary Contact Email(Required)

Primary Contact Office Phone(Required)

Primary Contact Cell Phone(Required)

Are you a third party logistics provider serving a retail location?(Required)

Please list the retailer(s) you are servicing(Required)

Are you a parent organization with more than one program pickup address (e.g. a retail chain with multiple store locations)?(Required)

If yes, each pickup location must register separately.

3. Secondary Contact Information

Secondary Contact Name

First Last

Secondary Contact Title

Secondary Contact Email

Secondary Contact Office Phone

Secondary Contact Cell Phone

4. Site Logistics

On Site Contact On Day of Pickup (if different than primary)

First Last

On Site Contact Cell Phone (if different than primary)

Requesting entity must have the capacity to accommodate a 53-foot trailer. Can your site accommodate this?(Required)

MRC allocates 3 hours to load mattresses. Can your site accomodate a live load 3 hour pickup window?(Required)

Select the number of expected units (mattresses and box springs to be counted separately.)(Required)

Requested service date(Required)

Requested Pickup Time Window(Required)

Will this be a recurring pickup?(Required)

Please note any site-specific restrictions, logistical concerns, or additional pertinent information.

5. Terms and Conditions

6. Confirmation

Signature(Required)

Print Name(Required)

Signature Date(Required)

Email of Signer(Required)

This is required in order to receive a copy of the agreement.

ATTENTION

THANK YOU FOR YOUR INTEREST

ATTENTION

Things to keep in mind...

1. Location Information

2. Contact Information

3. Secondary Contact Information

4. Site Logistics

5. Terms and Conditions

6. Confirmation