* 1. Store Name:

* 2. Please provide the name, email address and phone number for a store representative City of Boulder staff should communicate with about ordinance information, signage needs, etc. If you represent a grocery chain with multiple locations, please provide a store contact for each location in the City of Boulder.

* 3. The City of Boulder will be providing signage to all stores collecting the Disposable Bag Fee at no cost. The signage will describe the amount of the fee, emphasize that it is a mandatory fee imposed by the City of Boulder, not by the retailer, and briefly describe how fee proceeds will be used. Is there any other additional information you believe should be empasized?

* 4. Signage currently being developed for store use include varying sizes of posters for display inside and outside of stores, small signage for the checkout station, and cart corral signs. Are there additional types of signage you would like or locations you would put signage that are not listed?

* 5. If you currently offer an incentive to customers that bring resuable bags, please indicate it below. A list of current reusable bag incentives will be posted on the City of Boulder's website for the initiative.

* 6. Are you willing to have City of Boulder representatives conduct educational outreach at your store, either inside or outside, on scheduled dates in May, June and/or July? If so we will be in contact with the store representative to schedule.