Compost On The Go! Application Form Page1 / 1 100% of survey complete. Question Title * 1. What is your First Name? Question Title * 2. What is your Last Name? Question Title * 3. What is your Phone Number? Question Title * 4. What is your Email Address? Question Title * 5. What is your Home Address ( You Must live within a 10 Mile radius of our warehouse located at 1133 Wilso Drive Baltimore MD 21223 to qualify for our program ) Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Question Title * 6. How did you hear about the Compost On The Go program? Social Media - Instagram/Facebook/Twitter/TikTok Our Website Word Of Mouth Online Search Question Title * 7. What is your Household Income level? Between $0 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Above $75,000 Question Title * 8. Which ethnicity best describes you? White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 9. How many members are there in your household? 1-3 4-7 8 or more Question Title * 10. What is your current means of transportation? Walk Personal Vehicle Public transportation ( Bus, train) Paid transportation ( Uber, Lyft, Taxi) Question Title * 11. Do you currently compost at home or as part of a composting service/program in your community? Yes No Question Title * 12. Do you Understand this statement?4MyCiTy Inc. is a non-profit focused on environmental sustainability through the diversion of food waste from our landfills or waste management facilities to our unique line of onsite composting machines. I agree to place only approved waste items in the bags and follow the guidelines explained in my introductory call with the 4MyCiTy representative. Yes No Question Title * 13. I understand that I will need to send an Email on days that I would like my Compost On The Go Bags! picked up. Pickups are only scheduled in increments of 5 or 10 bags per pickup. and must be scheduled between 9am and 4pm Monday through Friday. Any special timeframe request must be discussed and approved by a 4MyCiTy representative. I Understand Question Title * 14. I agree and Understand that 4MyCiTy Inc. Is a nonprofit organization and is doing this service Free of charge to me and or my family on a voluntary basis. This program is not a guaranteed program and can end at anytime without notice. 4MyCiTy does not employ or is responsible for the DoorDash drivers assigned to pickups. This program is designed to help reduce food waste while effectively supporting composting within our communities. Your participation in the program is voluntary and can be terminated at any time at the discretion of 4MyCiTy leadership. Agree Type your name as acknowledgement Done