Montgomery County, MD Government
ECOWISE Registration
ECOWISE Program
Business Information
Name of Business or Organization
*
Business Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo - Brazzaville
Congo - Kinshasa
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
Hong Kong SAR China
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR China
Republic of North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé & Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
St. Barthélemy
St. Helena
St. Kitts & Nevis
St. Lucia
St. Martin
St. Pierre & Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
U.S. Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Phone Number (###-###-####)
*
Fax Number (###-###-####)
Contact Name
*
Position
*
Email
*
Business Structure
What category does your business fall under?
*
Business Trust
Corporation
General Partnership
Limited Liability Corporation (LLC)
Limited Liability Limited Partnership
Limited Liability Partnership (LLP)
Limited Partnership
Sole Proprietorship
Other
Other Business Category
Type of Business / Organization
Type of Business - Check All That Apply
*
Auto Service, Parts, Bodywork
Dry Cleaning
Government / Public Agency
Heating / Air Conditioning
Home / Building Contractor
Landscaping
Manufacturing
Medical / Dental
Painting
Photo Laboratory
Property Management
Printing / Publishing
Research / Laboratory
School / Educational Institution
Wood Working / Carpentry
Other
Other Type of Business
Affidavit
By the signing of this application document, I declare and affirm the following:
That the business or organization named above meets all the conditions of a Small Quantity Generator as defined by the Code of Maryland Regulations, Title 26, Subtitle 13, Section 02.05. (See chapter 4 & 5 of the handbook, Hazardous Waste Management in Montgomery County, the ECOWISE registration packet, or the Montgomery County website for a summary of the applicable regulations.)
I further understand that the business or organization named above will not be eligible to participate in the Montgomery County, Maryland ECOWISE program during any period that it does not meet the conditions of a Small Quantity Generator under the Code of Maryland Regulations.
I also agree that the company referenced above will abide by all conditions set forth in the Rules and Procedures for the ECOWISE Program and understand that the County may modify or terminate the ECOWISE Program at any time.
I declare and affirm, under penalty of perjury, that I am a person authorized and empowered by the company listed above to sign agreements and bind the company and that to the best of my knowledge, information, and belief, all matters and facts in this application are true and correct and that no false or misleading information has been provided.
Signature of Corporate President, Managing Member, Partner, or Owner
Signature (Type in your name)
*
Title
*
Date
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