Appendix B - Wanted Materials
Listing Form
Office Use Only
Code
#___________
Submit one form per listing : Copy as many forms as needed. Item
ID #__________
Company Name:_____________________________________Date: ____________
Address:____________________________________________________________
City: _______________________________State:______Zip Code:___________
Type of Business:___________________________# of Employees_______ S.I.C.
Code:______
Contact:___________________________ Title:_____________________________
Phone #: _____-_____-________ Ext. _____ ; Fax #:_____-_____- _________ ;
Toll Free #: 800- _____- _________; e-mail address: ________________________
Material Classification Code Number: __________ (select the one
category Code Number from the
list in Appendix A that best describes the materials you are listing)
Item / Material to be listed as Wanted: ___________________________________________
(generic name / main usable constituent)
Description:_________________________________________________________________
____________________________________________________________________________
(Provide detailed information as you wish to have it appear in the catalog listing:
include information
such as condition, amount, sizes, packaging, contamination. Limit is 250 charactors).
Possible Processes that generate the material:_____________________________________
(optional).
Supply of Material / Item: o On-Going o One Time Need
Quantity Wanted:__________________Units (ea., lbs., tons, cu.yds.):______
Desired Total Wgt._________o Wet, o
Dry
Future Quantity Wanted:__________________ Units (ea., lbs., tons, cu.yds.):______
Frequency (wk.,mo.,qtr.)________________
Necessary Support Documentation: o Sample o Lab analysis o MSDS o Photo
o Equip. Specs o Manual
Materials to be at: o No Charge, o Price Negotible, o Price/Unit: $__.___/ ____
Release Agreement:
The undersigned acknowledges to having read and agree to the terms of the DISCLAIMER and furthermore agrees to release M2X and its staff, sponsors, directors and advisors from any claim, liability, obligation, or responsibility resulting from, pursuant to, or connected to the listing of materials or any other matter related to the Maine Materials Exchange.
Signature:____________________________________ Date_____________________
A completed copy of this form may be mailed to M2X at 93 Maqouit Dr. Freeport, Me. 04032 or Faxed to 207-865-6478
For Assistance completing this form or for other information, Call M2X @ 207-865-6621 or contact Support@M2X.com