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Step 1 of 5: Contact Information
Admin Contact Information
Company Information
Remitter Type
Membership Agreement
Finish
This wizard walks you through registering as a new organization. Please provide the Admin Contact Information for your organization. The Admin Contact has authorization to make changes to your account profile information.
Admin Contact
I am continuing an existing application
* indicates required fields
First Name
*
*
Last Name
*
*
Title
*
*
Phone Number:
*
*
Email Address:
*
*
Invalid Email Address.
Confirm Email Address:
*
*
Email Address must match the confirm Email address
User Name:
*
*
User name already exists in the system. Please pick a diferent user name and try again.
The User name and Password combination is incorrect.
Password:
*
*
Password must be at least consists of 6 characters long
Confirm Password:
*
*
Please confirm your password.
I Confirm that I am authorized to register for LightRecycle Washington on behalf of this company
*
You must confirm you are authorized to register on behalf of your company.
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