COR-Registration Form

Get Started With COR

First Name:

First Name Field is Required First Name Should Contain only Alphabets

Last Name:

Last Name Field is Required Last Name Should Contain only Alphabets

User ID :

UserId is Required User ID can not contain any of the following characters (#!$%^&*()+=,/?\|[]{} space) UserId Should not contain blank Space User Id must be less than 30 characters UserId is already Exists

Password:

Password is Required

Passwords must contain at least six characters, including uppercase, lowercase letters and numbers

Re enter Password:

Confirm Password is Required Passwords do not match.

Job Title:

Email:

Email Address is Required Invalid Email Email already Exists

Country:

Facility:

Republic Services Facility is Required

Telephone:

Extension:

Mobile:

Fax:

Comments:

Customer and/or Generator ID# are identified on a Republic Services Invoice

Customer Generator EPA Number

Customer ID

Customer ID is not valid

Generator ID

Generator ID is not valid

EPA Identification

EPA ID is not valid

Customer/ Generator/ EPA Id is Required

By clicking on the button below labeled “I agree. Create my account.”, I hereby certify that the information provided above is correct to the best of my knowledge, information and belief and that I will update the information as necessary to maintain its accuracy .

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