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Application Form to become a new client

Please fill out and submit the form below.

Generator Information

Generator Name*
Generator Contact*
Title
Phone*
Address*
City*
State / Province*
Email*
  Purchase Order Required (Specify conditions) 

Billing Information (if different)

Customer Legal Name
Customer Contact
Title
Phone
Fax
Address
City
State / Province

Waste Stream Information

We will be using your
services for
  Dry Cell Batteries 
  Lead-Acid Batteries 
  Non-PCB Ballasts 
  Mercury Containing Lamps 
Returns Policy*
  We accept Nu-Life Industries Inc. reserves the right to return any items that cannot be processed through their operation. Furthermore we agree to accept all returned items which will be sent freight collect, using the same carrier (when practical) that delivered the materials. 
Terms*
We acknowledge that Nu-Life Industries Inc. invoices on a net 15 days basis. We understand and agree to a service charge of 2% per month, 26.4% per annum on accounts in excess of net 30 days from date of invoice. We promise to pay and hereby guarantee payment of any debts incurred by this company and authorize Nu-Life Industries Inc. to collect such debts individually or collectively, as allowed by law.
Image Verification*
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Your personal information provided is never stored online, sold and will not be used for any other purpose other than registering you as a new client.