JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Terra Works Program
Thank you for your efforts in working with us to make our community greener! We appreciate your support and willingness to make important changes to your spaces for your customers, employees and our planet. Hearterra wants to help businesses and organizations reduce their waste and single use plastic by supplying bulk refills for their everyday products. We would be happy to welcome you as a partner and look forward to working with you.
OUR
MISSION
To encourage happy, healthy living and zero-waste lifestyles.
OUR VALUES
WE CARE
- Tremendous care is taken to choose products, processes and services that are wholesome, benefit the environment first, are safe, efficient and of the highest quality.
WE ARE TRUE
- We are honest, pure, and true in our intentions and actions, and are compassionate, socially responsible and respectful with all our partners.
WE HAVE WHOLEHEARTED PASSION
-We make conscious choices that support the health of people and the planet. We engage in responsible partnerships (organic, Non-GMO, local, fair-trade) that foster environmental protection or sustainability and ethical treatment of workers and promote conscious consumerism in all we do.
WE ARE INNOVATIVE CURIOUS and FUN
- We solve problems using innovative technologies and aim for continuous improvement and education.
Please provide information to help us personalize your service as one of Hearterra's partners.
The data gathered in this survey will help us understand how this program is benefitting your
space and assist us in improving the program for you. Data will be stored on a Google file and will not be shared beyond the project partners.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Primary contact
(First & Last Name)
*
Your answer
Organization/Business Name
*
Your answer
Phone Number
*
Your answer
Organization/Business Address
*
Your answer
Business Number
(GST/HST Number)
*
Your answer
Please link your website URL below.
Your answer
Please tell us about your organization/business.
(Note: this answer may be used to showcase your organization/business on the Community Impact page on our website)
*
Your answer
Please select the products and the quantity that you would like Hearterra to supply:
*
Not Needed
Less than 500 ml
1L
4L
10 L
20 L
Hand soap
Hand sanitizer
Hand lotion
Multi-surface spray
Surface sanitizer
Kitchen and Bathroom Cleaner
Tiolet Bowl Cleaner
Baking soda
Vinegar (12%)
Yoga Mat Spray
Laundry soap
Fabric softener
Not Needed
Less than 500 ml
1L
4L
10 L
20 L
Hand soap
Hand sanitizer
Hand lotion
Multi-surface spray
Surface sanitizer
Kitchen and Bathroom Cleaner
Tiolet Bowl Cleaner
Baking soda
Vinegar (12%)
Yoga Mat Spray
Laundry soap
Fabric softener
How do you prefer to receive your goods?
*
Original Product Packaging
Plastic 4 L Jugs with pump top
Plastic 4 L Jugs
Mason Jars (16 or 32 oz with a deposit of $2.50 per jar)
Glass Bottles with pump top (500 ml)
10 L Bag-in-Box
20 L Jug with tap ($15 deposit)
Uncertain
Container Type
Original Product Packaging
Plastic 4 L Jugs with pump top
Plastic 4 L Jugs
Mason Jars (16 or 32 oz with a deposit of $2.50 per jar)
Glass Bottles with pump top (500 ml)
10 L Bag-in-Box
20 L Jug with tap ($15 deposit)
Uncertain
Container Type
Please select the products and the quantity that you would like Hearterra to supply:
*
Not needed
Less than 25
26 - 50
51 - 80
81 - 100
More than 100
Dishwasher tabs
Recycled Toilet Paper ($)
Bamboo Toilet Paper (High-quality - $$$)
Not needed
Less than 25
26 - 50
51 - 80
81 - 100
More than 100
Dishwasher tabs
Recycled Toilet Paper ($)
Bamboo Toilet Paper (High-quality - $$$)
How often do you anticipate requiring these products?
*
Weekly
Bi-weekly
Monthly
Bi-monthly
Not regularly
Uncertain
Order Frequency
Weekly
Bi-weekly
Monthly
Bi-monthly
Not regularly
Uncertain
Order Frequency
What environmentally sustainable products or brands would you like Hearterra to offer? Please be specific.
Your answer
Would your organization/business like to be recognized?
We would like to recognize your business on our Community Impact page. We want to show our gratitude and celebrate your success along the way!
*
Yes
No
Would you like to receive 10% off products purchased specifically for your organization/business?
*
Yes
No
Please use the space below to add any additional comments or questions you may have.
Your answer
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Hearterra.
Report Abuse
Forms
