Name:
*
Company:
Phone:
*
Email:
*
Do you want to join the Shred For The Cure team that donates 10% of our revenues to the Susan G. Komen For The Cure Cincinnati Affiliate?
*
Yes
No
Please list the services that you would like to implement:
*
Box Destruction
On-site Security Consoles
Kiosk Rentals
Kiosk Sales
Please state how many Boxes and/or On-Site Destruction Containers that you currently have for shredding?
Are you currently under a shredding contract?
Yes
No
If yes, what date does it end?
Which shredding company is your contract with?
What else do you want to tell us?
Security Code:
*
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