Name*
Title
Organization*
SIC Code
Address*
City*
State*	Zip Code*
County
Country
Work Phone*
FAX*
E-mail*
Web

Please check only one: Material Available   Material Wanted

Classification:
(review and select only ONE classification for your material)

Paper		Plastics
Metals & Metal Sludges		Rubber
Construction Materials		Shipping Material
Glass		Off-Spec Chemicals
Durables & Electronics		Wood
Textiles & Leather		Miscellaneous

Other Information
Please write a specific description of the material (generic name, physical state, color, particle size, contaminants)*:

Potential End Use*:

Packaged in: Bulk  Drums  Pallets  Bales 
Other

Present amount one time   Reoccurring

If reoccurring, quantity thereafter per week per month
per quarter per year

May we give your names and number to companies inquiring about your listing? yes no

Add your materials to Omex - Ohio Materials Exchange, a state-wide exchange, at www.aor-omex.org