Join RefillNotLandfill - Asia | Become a #RefillStation!
Thank you for your commitment to helping to reduce the use of single-use plastic bottles! If you have made it this far, you have already heard of our campaign, and would like to commit to making a difference!

By completing this form, you are agreeing to supply clean drinking water to anybody presenting a reusable or refillable water bottle and you agree that your business or organisation will appear on our map:

We hate forms too, so we have kept it to an absolute minimum and it's mostly copy/paste it should only take you a minute!

Who are you?
To make your life easier and to set your mind at ease, we only request information that is already in the public domain!
What is the name of your business/organisation? *
Your answer
What is your email address? *
Your answer
What is your name and position? *
Your answer
Please provide the link to your business/organisation facebook page. Here is a link to ours: (Please LIKE ours while you're there!) *
Your answer
Please share the website to your business or organisation
Your answer
Where are you?
To help us organise our campaign, please share some info about your location.
Where are you in RefillAsia? *
Please share the link to your business on Google Maps - *
Your answer
I would like to request the following (currently Cambodia Only but we can forward you the file to print your own)
RefillNotLandfill Community
Please join our partner group to keep up to date with happenings, and share ideas:
Are you interested in Customised Refillable Water bottles for your business or organisation? *
Captionless Image
Thank You!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service