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.
New/initial application (location never registered)
Change of ownership
Update/correction of current registration information
Other business names (DBAs)
Is mailing address the same as street address?
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)
Type of registration (Check all that apply)
Waste tire generator
Waste tire hauler
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.
Do you sell new motor vehicle or trailer tires?
(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).
Please select the regions in which you provide service as a waste tire hauler:
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.