Pre-Delivery Report for Self-Haul Facilities

Pre-Delivery Report for Self-Haul Facilities (CARE Public DoS)

NOTE: A pre-scheduled delivery date with the destination facility is required to complete this form. This form is intended as a notification to CARE of a pending delivery (Pre-Delivery Report). It will assign a Work Order number for invoicing reference.

This form is intended for use by a certified CARE California Public Drop-Off site to announce the delivery of a SCHEDULED Post Consumer Carpet (PCC) load to an authorized CSE/Processor.
Any related invoice(s) must reference the CARE Work Order number that is generated by this submission, and must include a certified weight ticket that documents NET Weight.
CARE Drop-Off Site*
Other Address
Street Address Address Line 2 City State ZIP Code
Drop-Off Site Contact Person*
Enter the information for the person CARE should contact in the event of questions and/or invoice issues.
First Last
Phone*
Email*
Delivery Information
Destination*
Please provide the name of the facility the load is being delivered to.
Scheduled delivery Date**
The date you have an appointment scheduled with a CARE CSE (Destination Facility). (This form does not replace scheduling with your destination facility.)
MM slash DD slash YYYY
Container type and size*
Type of Material Shipped*
- Mixed Carpet (Broadloom)
- Carpet Tile (Sorted)
STOP! This load is not authorized for reimbursement by CARE. Carpet Tile is not eligible for CARE DoS self-hauling reimbursement. All shipments of Carpet Tile must be negotiated under your CSE Agreement protocols. If you have any questions, please contact Cheryl Duran (cduran@carpetrecovery.org)
Notes / Comments
Photo Upload*
Please upload a photo of the container. Maximum 3 photos permitted.
Drop files here or
Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB, Max. files: 3.
CAPTCHA
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Destination*
Please provide the name of the facility the load is being delivered to.

Pre-Delivery Report for Self-Haul Facilities (CARE Public DoS)

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Pre-Delivery Report for Self-Haul Facilities (CARE Public DoS)

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