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Home
»
Forms
» Recycling Request Form
Recycling Request Form
*Required Fields
*Name:
Title:
*Agency/Organization:
*Address:
*City:
*State:
*Zip:
*Telephone:
Fax:
*
E-mail:
Which activities are you interested in?
(check all that apply)
Recycling
Destruction
Other
How soon would you be interested in these activities?
Select One...
Immediately
Within 30 days
Within 3 months
More than 6 months
Approximately how many pieces of equipment are, or will be, involved?
What type of equipment
are you retiring?
(check all that apply)
Laptops
Monitors
PCs
Printers
Other
Is the equipment?
Functional
Non-Functional
How did you
hear about us?
Select One...
Referral
Trade Show
Direct Mail
Direct E-mail
Direct Fax
Link from other site
Search Engine
Website
Please add any additional comments that you have concerning your equipment disposal needs.
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