Shorr Intake Form + Pre Assessment Questions

Business Intake

Business Information

Business Name:*

Shorr's Customer Number:*

Shorr's Ship to:*

Location Name (if different):

Business Address:*

Primary Contact Name:*

Phone*

Email:*

Assessment Completed By:*

Date*

Month

Day

Year

Site Assessment (Completed by Operator)

Number of Rack'nPaks Needed:*

Recommended Rack'nPak Location(s):*

Storage Space Available for Collected Film:*

Limited

Adequate

Extensive

Your pick up date will be date of delivery.

Preferred Collection Frequency: (If helpful, please note the capacity is 30-40 pounds of film, equivalent to one gaylord full.)*

Weekly

Bi-Weekly

Monthly

As Needed

What motivated your business to participate? (check all that apply) *

Reduce waste

Sustainability goals

Employee engagement

Corporate initiative

Customer/community expectations

Free/cost savings

Curiosity/pilot opportunity

Other

If other, please state here:

How prepared does your team feel to participate in the collection program? 5 = Very prepared 1 = Not prepared *

What do you expect will be the biggest challenge? (Multiple Choice – select 1)*

Staff participation

Space/storage

Knowing what materials are accepted

Keeping materials clean

Collection logistics

Time/capacity

Other

If other, please state here:

This form is to be completed by the operator/recruiter.

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