Receptacle Application Form
This application is strictly for Businesses/Organizations with a storefront ONLY within the City Limits of Statesboro, GA. Keep Statesboro-Bulloch Beautiful has been awarded a grant from Keep America Beautiful that allows for local it's affiliates to supply areas/businesses in the community with cigarette receptacles and pocket ash trays to help collect and cut down on cigarette litter FREE of charge. The name of the grant is called the Cigarette Litter Prevention Program. This program not only seeks to collect cigarette litter, but it recycles the cigarette litter via TerraCycle.

APPLICANTS: to be considered for a cigarette receptacle, you must fill out the entire application thoroughly and honestly. A submittal of the application does not guarantee the items that you request. Receptacles will be awarded to those that are most in need and until supplies last. Those that do not receive a receptacle this year will be placed on a waitlist for next year's grant.

Keep Statesboro-Bulloch Beautiful is a direct affiliate with both Keep America Beautiful and the City of Statesboro.
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What is the name of your business/organization? *
What is the address of your business/organization? *
Name of the main contact for the business/organization? *
Main contact's email: *
Main contact's phone number: *
Which collection stand are you requesting for your business/organization? *
Explain your need for a receptacle near/for your business: *
Are you willing to help and notify Keep Statesboro-Bulloch Beautiful when the receptacles are full and need to be emptied? *
Any additional comments?
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