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This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for information purposes only. Currently, the following states regulate the offer and sale of franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington and Wisconsin. If you are a resident of, or want to locate a franchise in, one of these states, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your state, or have identified an exemption from such requirements. Franchise offerings are made by Franchise Disclosure Document only.

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Please complete the following information to be considered for a potential SharpsMD® development opportunity. Please note that this form will take several minutes to complete.


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Questionnaire


*What initially drove you to visit our franchise development website?
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As part of our review of your application, Waste Alliance® will obtain a credit report and investigative consumer report on you from a consumer reporting agency. By submitting this application, you acknowledge and agree to Waste AllianceTM obtaining your credit report and investigative consumer report.

You have the right to request disclosure of the nature and scope of the investigation that we will request about your background. If you would like such a disclosure, please submit a request to us in writing. You also have the right to request a written summary of your rights under the federal Fair Credit Reporting Act, Title 15 United States Code, Section 1681g(c).

This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for information purposes only. Currently, the following states regulate the offer and sale of franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington and Wisconsin. If you are a resident of, or want to locate a franchise in, one of these states, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your state, or have identified an exemption from such requirements. Franchise offerings are made by Franchise Disclosure Document only.

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