E-waste Pick-up form

E-waste Pick-up Request Form

Date of Request

Requested by

Street Address City State Zip

Site Information

Contact on the day of pickupPickup Location Address Street Address City State Zip Location of designated parking area

E-Waste Information

Enter in the number of electronics. Note: We accept all computer-related cables of any quantity. No techno trash: CDs DVDs and manuals. No stand-alone speakers. Input this code