E-waste Recycling Request
Company Name
*
Contact Name
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
This is the address where the COD will be sent to.
1st Stop
*
Please Select
Shady Shores Elementary
Lake Dallas Middle School
Corinth Elementary
Lake Dallas Elementary
Lake Dallas High School
Please choose in order of pick up
Address 1
2nd Stop
Shady Shores Elementary
Lake Dallas Middle School
Corinth Elementary
Lake Dallas Elementary
Lake Dallas High School
Address 2
Shady Shores Address
Middle School Address
Corinth Elementary Address
LD Elementary Address
LD High School Address
3rd Stop
Shady Shores Elementary
Lake Dallas Middle School
Corinth Elementary
Lake Dallas Elementary
Lake Dallas High School
Address 3
4th Stop
Shady Shores Elementary
Lake Dallas Middle School
Corinth Elementary
Lake Dallas Elementary
Lake Dallas High School
Address 4
5th Stop
Shady Shores Elementary
Lake Dallas Middle School
Corinth Elementary
Lake Dallas Elementary
Lake Dallas High School
Address 5
Data Destruction?
*
Yes
No
Onsite or Offsite Destruction
*
Onsite
Offsite
Do you need a Certificate of Destruction?
*
Please Select
Yes
No
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Accepted Items List
PC's
Please estimate number of units
Laptops
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Servers
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Lcd's
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Small Printers
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Large Printers
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Network Equipment
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Phones
Please estimate number of units
Other
please briefly describe
Form
Barcode - Internal Use Only
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