Membership Form

For the Plastic Loose Fill Council's national reuse/recycle program for plastic packaging peanuts.

With your membership, you will receive listing in our 800# directory and a kit of information to use in your store.

To join please print and mail this form to: Plastic Loose Fill Council, P.O. Box 21040, Oakland, CA 94620. Please make your check out to: Plastic Loose Fill Council.
INVOICE
$30.00 ONE YEAR MEMBERSHIP
$50.00
TWO YEAR MEMBERSHIP
$20.00 Same owner for each additional store
one year membership
$35.00 Same owner for each additional store
two year membership

Information we need:

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Store phone #

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Store name

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Street Address (No. P.O. Box)

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Location (e.g., shopping center)

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City/State/Zip + four

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Store owner/contact name                Fax#