State of North Carolina Department of Environment and Natural Resources Registration Form for Television Manufacturers NC Senate Bill 887 places statutory requirements on television manufacturers as follows: 1. Television Manufacturers, before selling or offering for sale televisions in the State of North Carolina, must register with the Department of Environment and Natural Resources (DENR) and, at the time of registration, shall pay an initial registration fee of $2,500 and an annual renewal registration (no later than June 30) for each fiscal year thereafter. The initial registration shall be valid from the day of registration through the last day of the fiscal year in which the registration fee was paid. The proceeds of these fees shall be credited to the Electronics Management Fund. CHECK HERE -You are not required to pay a fee if you are a television manufacturer selling globally 1,000 televisions or fewer per year. You are exempt from the requirement to pay the registration fee and the annual renewal fee. CHECK HERE -You are not required to pay a fee if you are a manufacturer selling televisions to non-consumers only (non-profits who employ greater than 10 people and businesses). 2. Manufacturer Label Required. - A television manufacturer shall not sell or offer to sell any television in the State of North Carolina unless a visible, permanent label clearly identifying the manufacturer of that device is affixed to the equipment. 3. Recycling of Market Share Required. - The obligation to recycle televisions shall be allocated to each television manufacturer based on the television manufacturer's market share. A television manufacturer must annually recycle or arrange for the recycling of its market share of televisions. 4. Due Diligence and Compliance Assessments. - A television manufacturer shall conduct and document due diligence assessments of the recyclers the manufacturer contracts with, including an assessment of compliance with environmentally sound recovery standards adopted by DENR. 5. Contact Information Required. - A television manufacturer shall provide DENR with contact information for the manufacturer's designated agent or employee whom DENR may contact for information related to the manufacturer's compliance with the requirements of this section. 6. Joint Television Recycling Plans. - A television manufacturer may fulfill the requirements of this section either individually or in participation with other television manufacturers. 7. Annual Report. - A television manufacturer shall report to DENR by October 1 of each year the total weight of televisions the manufacturer collected and recycled in the state during the previous fiscal year. Manufacturer Information Manufacturer Name: Date: Manufacturer Street Address (headquarters/main office): State or Province: City: Postal (ZIP) Code: Country (if other than U.S.): Manufacturer Website (URL): Manufacturer's Toll Free Recycling Phone Number: Contact Information Contact Name: Title: Company / Organization (if different from Manufacturer): Telephone Number: E-mail Address: Mailing Address (Street, Route, or PO Box): State or Province: NC DENR - Electronics Management Program City: Postal (ZIP) Code: Page 1 of 2 Country (if other than U.S.): Television Manufacturer Registration (6/12) Brands Information Currently Manufactured Brand Name Make checks payable to: North Carolina Department of Environment and Natural Resources. Write "Electronics Management Program Fee" on the check. Mail to: NC DENR - DWM Solid Waste Section - Electronics Management Program Mail Service Center 1646 Raleigh, NC 27699-1646 NC DENR - Electronics Management Program Completed forms can be sent separately via e-mail to: electronic_recycling@ncdenr.gov Page 2 of 2 Television Manufacturer Registration (6/12)