Certified Electronics Reuse & Recycling Service Request

Certified Electronics Reuse & Recycling Service Request

All solutions providers are either e-Stewards and/or R2v3 Certified
General Information
Job Type
Job Requester Name

First NameLast Name
Job Requester Email
example@example.com
Date Submitted

MonthDayYear
Date
Job Reference Number
Unique Number
Preferred Pickup Date

MonthDayYear
Date
Pickup Date (Range)
MM/DD to MM/DD
Documentation Needed
Pickup Location, Contact, and Instructions
Company/Organization
Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Person
Name or Company/Organization Contact
Contact Person Phone
Please enter a valid phone number.Format: (000) 000-0000.
Contact Person Email
example@example.com
Description of Equipment to be Collected
Descriptions/Quantities/Notes/etc.
Equipment Needed
Palettes Needed (Qty.)
Estimated
Pickup Instructions
Loading Dock (Yes/No)
Site Up Multiple Floors
Is an Elevator Available
Images & Files
Upload Digital Assets

File Types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
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General Information