California Carpet Stewardship Program – Special Assessment Consideration Form

AB 2398 California Assessement Collection & Payment Form - Single Sale

Special use, by invitation only. Future sales into CA will require your company to register with CARE, sign an applicable Membership Agreement and report all sales on an ongoing basis . All information provided in this form is deemed Confidential Business Information (CBI) but is necessary for audits and verification.

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This field is for validation purposes and should be left unchanged.

Failure to submit assessments on time may cause your account to incur additional fines and fees, and may trigger enforcement penalties.

Sale of carpet which is noncompliant is a violation that may result in penalties of up to $10,000 (or more) per day. For more information on the California Carpet Law (AB 2398), please visit calrecycle.ca.gov/Carpet

Type of Business*

Full Company Name*

Provide the legal name of company

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Website*

Company Contacts

Please provide two main contacts who can validate any provided information on this form.

Contact #1 Information

Name*

First Last

Email*

Phone*

Is this a cellular phone?*

Yes

Contact #2 Information

Name*

First Last

Email*

Phone*

Is this a cellular phone?*

Yes

Product Manufacturer Information

Manufacturer of Product*

Manufacturer Location/Address*

Same as Company Above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Manufacturer's Website*

Manufacturer Contact Name*

First Last

Email*

Phone*

Product Information

Please provide details on the product being sold and/or shipped into California for sale.

Manufacturer's SKU or Product ID*

Product Description*

Face Fiber Type*

(Nylon, Polyester (PET), PTT (Triexta Polyester) Carpet Fibers, Polypropylene or Olefin Carpet Fiber, Wool Carpet, Blended, etc.)

Backing Type*

(Latex, polyurethanes,thermoplastics, etc.,)

Product Sale Information

Type of Product*

Date of Sale*

How much post consumer content is used in the manufacturing of the product sold?*

If this information is not listed on the product's specification page, please contact the manufacturer directly.

Broadloom Carpet - Less than 10% PCC *

Total Square Yards Sold

Price: $0.70

Broadloom Carpet - 10% PCC or greater *

Total Square Yards Sold

Price: $0.68

Carpet Tile- Less than 10% PCC *

Total Square Yards Sold

Price: $0.99

Carpet Tile- 10% PCC or greater *

Total Square Yards Sold

Price: $0.97

Sold to:*

Enter Full Name of Customer (if commerical customer, enter name of Company/Organization)

Customer Email*

Customer Telephone*

Customer Delivery Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Copy of Order / Sales Ticket*

Provide a copy (PDF only) of the order and sales ticket showing the assessment was collected at the time of purchase. All invoices must have the assessment clearly and correctly labeled as a separate line item after sales tax calculation.

Drop files here or

Accepted file types: pdf, Max. file size: 256 MB.

Total Assessment Due

An invoice for the above total assessment due will be sent to Contact #1 listed in the form via email. Assessments must be paid by Electronic Funds Transfer (EFT) to the bank account AND by the due date and time listed on the invoice.

AB 2398 California Assessement Collection & Payment Form - Single Sale

Company Contacts

Product Manufacturer Information

Product Information

Product Sale Information

2025 Annual Report Public Workshop Announced

Find carpet reclamation partners in your area

Products Made with Recycled Carpet

AB 2398 California Assessement Collection & Payment Form - Single Sale

Company Contacts

Product Manufacturer Information

Product Information

Product Sale Information

Find carpet reclamation partners in your area

Products Made with Recycled Carpet

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