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Waste Tire Application for Certificate of Registration (WT-1)
Do not use this form for registration renewal.
Only retailers that sell new tires must collect and remit waste tire fees.
Registration category
*
New/initial application (location never registered)
Change of ownership
Update/correction of current registration information
Enter Certificate of Registration Number
Business name
*
Other business names (DBAs)
Street address
*
City
*
County
*
State
*
Zip
*
Is mailing address the same as street address?
Yes
Mailing address
City
State
Zip
Business phone number (xxx-xxx-xxxx)
*
Business email address
*
Business owner (first, middle initial, last)
Owner business phone no. (xxx-xxx-xxxx)
Business manager (first, middle initial, last)
Manager business phone no. (xxx-xxx-xxxx)
Contact person (first, middle initial, last)
*
Contact business phone No. (xxx-xxx-xxxx)
Contact email
*
Type of registration (Check all that apply)
*
Waste tire generator
Waste tire hauler
End user
Waste tire processor*
Mobile waste tire processor*
Waste tire collection facility*
Waste tire monofill*
*
These registration categories require establishment of financial assurance prior to application submittal and approval.
Waste tire hauler destination facility name
*
Waste tire hauler destination facility address
*
Waste tire hauler destination facility city
*
Waste tire hauler destination facility state
*
Waste tire hauler destination facility zip
*
Do you sell new motor vehicle or trailer tires?
Yes
(Only retailers that sell new tires must collect/remit waste tire fees.)
Please choose your method of waste tire fee payment.
*
As a single location (WT-6)
As multiple locations (WT-9)
Number of vehicles to be used to transport waste tires.
*
Number of contracted/freight carrier temporary decals. (There are six decals to a sheet. Enter the number of decals you need, not the number of sheets. These decals are only required if you will have a contracted commercial or common freight carrier haul waste tires under your registration.)
Do you haul waste tires for other businesses and customers? (Choose “No” if you only haul waste tires for your business, and you do not haul/pick up waste tires from other businesses or customers).
*
Yes
No
Please select the regions in which you provide service as a waste tire hauler:
Metro
Pikes Peak
Northeast
Southeast
Southwest
West Central
Northwest
When you hit Submit, a copy of the completed form will be sent as an attachment to the contact person's email address and you will be re-directed to the waste tire web page.
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