Your customer account number is found on your Utility bill
A confirmation email will be sent to this address
PLEASE NOTE: Unit(s) must be plugged in and cooling at time of pick-up
I swear or affirm under penalty of perjury under the laws of the State of Colorado that:
I understand that this sworn statement is required by law because I have applied for a public benefit.
I understand that state law requires me to provide proof that I am lawfully present in the United States when asked
as well as submission of a secure and verifiable document. I may also be required to provide proof of lawful presence.
I further acknowledge that making a false, ficitious, or fraudulent statement or representation in this sworn affidavit
is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute
18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
To participate in the Refrigerator and Freezer Recycling Program, you must sign the
following statement certifying your ownership rights to the appliance(s):
I certify that I am the owner or owner's representative of the above appliance(s) and that this ownership is free of liens,
security interests or other encumbrances. I hereby transfer ownership of the above appliance(s), when picked up, to Appliance Recycling Centers of America (ARCA).
I understand that my appliance(s) must meet the size requirement and be operating and cooling at the time of collection.
I further understand that if my appliance does not qualify at the time of pickup, I will not be eligible for any utility bill credit.
Utility bill credits will be shown on bill within eight weeks of the pickup date.
I further certify by signing this form that I release the City of Fort Collins Utilities and
its respective sub-contractor(s) from any and all claims resulting from the removal of the appliance(s) from the above cited premise.